Questions surround updated COVID-19 vaccine guidance, coverage

Federal, state and scientific authorities are clashing over COVID-19 vaccine guidance. Many people are left wondering if and how they should get the shot this year — and if insurance will cover it.

In the past year, COVID-19 infections have killed 581 Massachusetts residents, and 75 more are suspected to have died from COVID-19. Cases are creeping back up. At the same time, the nation’s top health official is rolling back recommendations on COVID-19 vaccines. 

Confusion amid new federal guidance 

The Food and Drug Administration approved the most recent COVID-19 vaccines this past week — but only for adults over the age of 65 as well as those with certain underlying physical and mental health conditions. The full list can be found at the CDC website. 

The policy change comes after months of major Centers for Disease Control and Prevention staffing changes, concerns that health and science experts are being shut out of the vaccine policy development process, and allegations that Health & Human Services Director Robert F. Kennedy, Jr. has directed CDC policy based on eugenics. 

Kennedy announced in May that the CDC would no longer recommend COVID-19 vaccines for healthy children and pregnant women, despite contradicting evidence-based recommendations from FDA Commissioner Marty Makary. 

The CDC director has also criticized mRNA vaccines and cut $500 million dollars in mRNA vaccine research and development, citing misinformation to support his claims. In June, he hand-picked a new slate of vaccine advisors to the nation’s Advisory Committee on Immunization Practices  — many of whom may lack appropriate experience for the position or even hold anti-vaccine biases.

Last week, it was reported that the Trump administration removed CDC Director Susan Monarez from her position weeks after being sworn in. Multiple CDC leaders have resigned since, citing concerns that politics are taking precedence over science. 

Recently, The American Academy of Pediatrics broke with CDC guidance and is instead urging COVID-19 vaccinations for children between 6 months and two years old. The American College of Obstetricians and Gynecologists has also uncoupled from CDC guidance, issuing a statement that it will “continue to recommend the use of updated COVID-19 vaccines in individuals contemplating pregnancy, and in pregnant, recently pregnant, and lactating individuals.”

Massachusetts officials also disagree with Kennedy’s recommendations: Governor Maura Healey has proposed divorcing Massachusetts from Kennedy’s vaccine plan. The legislation is written into a bigger health care funding bill, and would empower the Massachusetts Department of Public Health to set vaccine recommendations independent from federal standards. Healey’s office released a statement asserting that Massachusetts will “make sure that people get the vaccines they need — no matter what the Trump Administration does.”

Massachusetts Executive Office of Health and Human Services officials have not returned Waltham Times’ request for comments on whether Massachusetts residents under the age of 65 will require a prescription for the COVID-19 vaccine or whether Massachusetts’ public insurance — Medicaid — will cover the cost of the vaccine. 

Federal changes may impact insurance coverage 

Private health insurance companies are required by law to cover only federally recommended vaccines. Healthy individuals who are not pregnant and between the ages of 2 and 64 years old may have to pay out of pocket for the shot. At current rates, that could cost $140.

Those under the age of 65, and those seeking access for their children, may need to consult with their primary health care practitioners to access the vaccine and determine insurance coverage. Many may need to obtain a provider’s prescription to obtain the shot.

Charles River Community Health’s CEO Matt Mullaney shared that while some 2024-2025 vaccines may still be available locally — and may be covered by insurance — there is a very limited number, they are set to expire soon, and the recommendation is to get the most up-to-date vaccine once it is available.

Making your decision 

Klavdia Brisson, DNP, is CRCH’s chief clinical officer. She confirms that “vaccines are an essential part of preventive care to help protect individuals and the broader community from serious, and often preventable, diseases.” 

Waltham Director of Public Health Michelle Feeley said the city follows State of Massachusetts guidance when it comes to COVID-19 vaccines.  “[The] Health Department follows the guidance of the State Department of Public Health,” she explained. “Whatever they put out for the public is exactly what we will put on our website and social media platforms.” 

The Commonwealth, however, has not yet published COVID-19 guidelines for 2025-2026. Guidance for the previous season indicated that “everyone 6 months and older should get an updated 2024-2025 COVID-19 vaccine.” 

CRCH’s Mullaney stated that “we have not received any clear guidance yet from the CDC or from MA DPH” on “what this upcoming [COVID-19] season will look like.” He explained that the delay may in part be because “we’re waiting for an advisory panel to meet… that guidance will drive what pharmacists can do.”

That advisory panel, ACIP, is not scheduled to meet until September 18 — later in the year than usual. That late meeting date is pushing back the availability of the COVID-19 shot for Massachusetts residents.

“We’ll know a lot more by the end of September,” Mullaney said. 

For those concerned that they do not meet federal guidelines for receiving a COVID-19 vaccine this year, Mullaney notes that “providers have always been able to recommend medications off-label.” In other words, primary care practitioners will still be able to offer the updated COVID-19 vaccine to anyone who needs or wants it. 

Where in Waltham to get the COVID-19 vaccine

Waltham residents looking for this year’s updated COVID-19 vaccine will have several options around town, but may have to wait several weeks until ACIP meets and provides official recommendations to pharmacists.

• Charles River Community Health, 43 Foundry Ave.:
  (781) 693-3800
  Waltham residents who are existing Charles River Community Health patients can contact the clinic to schedule a vaccine appointment and ask questions about insurance coverage. Those who are not yet patients at Charles River are also encouraged to contact the center to access care and vaccines.
  
• CVS Pharmacy, 12 Harvard St:
  (781) 894-4522
  Patients will need a prescription to receive a COVID-19 vaccine at CVS. 
  
• CVS Pharmacy, 51 Linden St:
  (781) 894-1600
  Patients will need a prescription to receive a COVID-19 vaccine at CVS. 
  
• CVS Pharmacy, 800 Lexington St:
  (781) 893-2070
  Patients will need a prescription to receive a COVID-19 vaccine at CVS.
  
• Walgreens, 15 Main St:
  781-642-8711
  Customers are urged to contact their local pharmacy directly for questions about vaccine availability. 
  Patients may need a prescription to receive a COVID-19 vaccine at Walgreens. 
  
• Walgreens, 20 Weston St:
  781-891-9525
  Updated COVID-19 vaccines will be available by appointment or walk-in; customers are urged to contact their local pharmacy directly for questions about vaccine availability. 
  Patients may need a prescription to receive a COVID-19 vaccine at Walgreens. 
  
• Watch City Pharmacy, 923 Main St.: 
  781-472-2281
  
• More pharmacies can be found at https://vaccinefinder.org/