As Trump administration health officials seek to reshape vaccine policy — which could impact insurance coverage of certain immunizations for millions of Americans — Pennsylvania lawmakers have proposed new requirements aimed at "protecting access" to those vaccines.
State Rep. Arvind Venkat, a Pittsburgh-area Democrat and emergency room physician, has introduced a measure that would require insurers to continue covering all vaccines that were included in the federal framework as of Jan. 1, 2025. It would also require coverage for new vaccines recommended by the Pennsylvania Department of Health.
"As a physician, I know how powerful vaccines at all stages of life can be for preventing or mitigating disease," Venkat said.
Venkat is urging state lawmakers to take up his bill after the FDA limited its approval of the updated COVID-19 vaccines Wednesday to individuals aged 65 and older or for those aged 5 and older with an underlying condition that puts them at high risk for severe outcomes from COVID-19. Venkat called the new restrictions "catastrophic" and a sign of future vaccine limitations to come.
Without the FDA's blessing, insurance providers may be less likely to cover COVID-19 vaccines for populations outside of those stipulated in the new restrictions, and a vaccine without insurance could cost as much as $200, according to GoodRx. Healthy individuals who want a COVID-19 vaccine would likely have to find a provider willing to administer it off label.
Venkat painted the new limitations as the latest in an anti-vaccine campaign led by Trump Health Secretary Robert F. Kennedy Jr. He argued the historic measles outbreak in the U.S. is a result of anti-vaccine sentiment.
"This is a major issue we are already seeing the consequences of with the recent measles outbreak across the country and the non-evidence-based restrictions on access to COVID immunizations," Venkat said.
The bill, which sits in the House Insurance Committee, would require insurers to cover approved vaccines without cost-sharing requirements. The state's Department of Health would make determinations about which vaccines insurers would be required to cover by consulting with major health organizations.
The list of those organizations includes the American College of Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the Infectious Diseases Society of America and the Society for Maternal-Fetal Medicine.
The department may also require coverage of a vaccine if it is recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) or if immunizations would "advance public health" by reducing the spread or severity of an infectious disease. Immunization of certain populations could be required if supported by medical evidence.
The bill — co-sponsored by two dozen other democrats including health professionals Bridget Kosierowski and Tarik Khan — was initially circulated earlier this summer amid the White House's overhaul of a Centers for Disease Control and Prevention advisory panel.
Until this year, U.S. health officials recommended yearly COVID-19 vaccinations for everyone older than six months, aligning with guidance from the CDC's advisory committee.
But Kennedy fired and replaced every member of that committee earlier this year. And the new committee, which features several prominent vaccine skeptics, has yet to make recommendations pertaining to COVID-19 vaccines.
Still, Venkat has already raised concerns about the "relevant experience" of the new appointees and whether their decisions would be made with "scientific justification."
"As ACIP calls into question the scheduling of vaccines for the flu, measles, mumps, rubella, and chicken pox, we need to act before it is too late," he said.
The FDA's COVID-19 vaccine limitations puts the agency at odds with the leading organization of pediatrics in the United States, the American Academy of Pediatrics.
AAP issued its updated vaccine recommendations last week, recommending a COVID-19 vaccine for all children ages six through 23 months "to help protect against serious illness." The organization also recommends the COVID-19 vaccine for all children two through 18 years of age in certain risk groups such as those who are at high risk for severe infection, those who live with individuals at high risk for severe infection, as well as those who have never been vaccinated against COVID-19.
AAP said children who do not fall into a risk group, but whose parent or guardian wishes to have the protection of the vaccine should receive one.
Under the proposed Pennsylvania protections, insurers found violating the requirement could have their license suspended or revoked, be blocked from acquiring a new license or pay a fine up to $10,000.
The FDA announcement Wednesday came hours before another shakeup at the Centers for Disease Control and Prevention. The Trump administration fired CDC Director Susan Monarez, who was confirmed to the position just under a month ago.
Her lawyers claimed Monarez had been targeted for refusing to "rubber-stamp unscientific reckless directives" and for "protecting the public over serving a political agenda."
"This is not about one official. It is about the systematic dismantling of public health institutions, the silencing of experts, and the dangerous politicization of science," the statement from attorneys Mark Zaid and Abbe David Lowell continued. "The attack on Dr. Monarez is a warning to every American: our evidence-based systems are being undermined from within."
Monarez was nominated by President Trump and confirmed to the position by the Senate in late July by a thin margin. Pennsylvania's senators were split on her nomination: Democrat John Fetterman voted against her while Republican Dave McCormick voted in support.
McCormick did not respond to a request for comment about Monarez's exit Thursday.
Monarez's departure coincided with resignations this week of several top CDC officials including the agency's deputy director, head of the National Center for Emerging and Zoonotic Infectious Diseases, head of the National Center for Immunization and Respiratory Diseases and the director of the Office of Public Health Data, Surveillance and Technology.
Pittsburgh-area pharmacies, health providers grapple with changing policies
With the FDA's approval, manufacturers will begin shipping supplies of the updated COVID-19 vaccine "immediately," according to a statement from Pfizer-BioNTech. But it's not clear when Pittsburgh-area doctors and pharmacists could begin administering the shots.
UPMC nor Allegheny Health Network responded to a request for comment regarding COVID-19 vaccines.
Giant Eagle — which recently took on hundreds of former Rite Aid customers amid the chain's bankruptcy — said its pharmacies are awaiting guidance from the CDC's advisory panel, which they expect "in the coming weeks."
"Once federal guidance is finalized, Giant Eagle Pharmacy will administer COVID-19 vaccines in alignment with that guidance," a spokesperson said in a statement.
The company said it did not yet know exactly when shipments of the vaccines would arrive at its Pittsburgh-area locations.
"Once the vaccine is available in our pharmacies, eligible patients will not need to make an appointment as we offer vaccines on a walk-in basis," the spokesperson said.
The Allegheny County Health Department said Thursday that it was concerned the vaccine limitations could "hinder equitable access" to the vaccine "especially for uninsured and underserved communities."
"We are concerned that the guidance seems to shift away from the scientific evidence which continues to strongly support broad public protection," a health department statement said.
"We encourage individuals to consult with their primary care provider to make informed decisions about vaccination based on their personal health status and the most current scientific recommendations," the department said.
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