In the midst of a rocky rollout, San Diego County public health leaders are still encouraging residents to stay up to date on vaccinations, including a new COVID-19 vaccine intended to respond to current strains of the virus.

When federal health authorities issued their recommendations for the next round of COVID-19 booster shots, expanding eligibility to all individuals aged 6 months and older, the expectation was that these additional doses would become readily available at local pharmacies without delay. However, after two weeks, consumers have started reporting a range of issues. Some people have discovered that certain stores have not yet received any booster doses, while others have encountered confusing obstacles related to their insurance coverage.

Jennifer Kates, the Senior Vice President and Director of the Global Health & HIV Policy Program at the Kaiser Family Foundation (KFF), shared her perspective, saying, "The rollout has faced unexpected challenges. While some level of difficulty was anticipated, the process has appeared to be more disorganized than initially predicted."

A recent survey conducted by KFF revealed that there is plenty of demand, approximately half of all adults in the United States, to receive the new COVID vaccine this autumn, with two-thirds of seniors among them. This level of interest far surpasses last year's bivalent booster vaccines, of which only around 17% of Americans received.

The problems include difficulties related to insurance coverage. With the government no longer providing the shots free of charge, most individuals are now required to rely on their health insurance to cover the costs.

"This is the first time that the vaccines are being commercialized. They're being largely procured, supplied, and paid for in the private sector. So it's sort of our health care system as we know it," Kates says.

Insurers appear to have overlooked this directive or have been slow in adapting their systems to make it a seamless process for consumers. Kates noted an instance where a colleague of hers attempted to receive the vaccine at a pharmacy outside her plan's network, and her insurer declined coverage, a practice that "actually goes against federal laws and regulations," according to Kates.

Even if no pharmacy within a plan's network has the vaccine available, insurers are supposed to cover it, even if it's an out-of-network facility, Kates emphasized.

This situation is posing challenges for pharmacies as well, according to John Beckner, Senior Director of Strategic Initiatives for the National Community Pharmacists Association, which represents independent drug stores across the country, including those in underserved rural and urban areas.

Beckner highlighted that some pharmacies are encountering issues with insurers failing to reimburse them for the vaccine. This might be because many insurance systems have not yet adapted to the new vaccine rules, now that the public health emergency has concluded and the federal government is no longer covering the costs.

In the past, insurance plans only needed to reimburse pharmacies for administering the vaccine, not for the vaccine product itself. "I don't think the health insurance plans adequately prepared for the vaccine rollout," he remarked.

Despite these challenges, pharmacies often provide the vaccine to consumers even before these issues are resolved, placing the financial burden on the pharmacies until the matter is rectified.

America's Health Insurance Plans, the trade association representing health insurance plans, stated in a response to NPR that insurers are indeed covering the new COVID vaccine. They further indicated that they are collaborating with pharmacies, government agencies, and other stakeholders to ensure that consumers do not incur any costs.