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Kennedy's changes may lead to varied insurance coverage

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Experts warn of risks to patient health from dropped

vaccine

recommendations

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Insurers to look to medical organizations for advice given

changes at CDC

By Amina Niasse and Julie Steenhuysen

NEW YORK, June 25 (Reuters) - Health insurers are

considering new expert sources to help determine which vaccines

to pay for as anti-vaccine activist and now U.S. Health

Secretary Robert F. Kennedy Jr. begins to revise government

recommendations for inoculations, according to multiple

insurance industry insiders and experts.

Last month, Kennedy dropped the U.S. Centers for Disease

Control and Prevention's recommendation that healthy children

and pregnant women should receive COVID-19 booster shots.

He has since fired the entire 17-member panel of outside

vaccine experts that reviews data for the CDC and recommends who

should get them, saying they had conflicts of interest without

providing evidence of any such conflicts. Kennedy then replaced

them with eight of his own selections - about half of whom have

advocated against some vaccines.

At least two CDC staff members have also left over Kennedy

decisions. The new group meets officially on Wednesday for the

first time.

Two industry organizations, two industry consultants and two

insurers told Reuters that the insurance industry would continue

covering vaccines recommended by the CDC panel, known as the

Advisory Committee on Immunization Practices. But if ACIP drops

recommendations, insurers may seek input from professional

medical associations and weigh other scientific evidence, they

said.

Elif Alyanak, a consultant at health firm Avalere, said

insurance coverage may start to vary. Insurers are required by

the Affordable Care Act to cover vaccines that are listed on the

ACIP committee's schedule, according to the CDC's website.

"Without ACIP making that official recommendation, we won't

see the same mandated coverage," said Alyanak, adding that

health plans will need to decide if dropped vaccines were still

worth covering.

That could lead to confusion for patients and providers, she

said. "If a patient is vaccinated, it won't be immediately clear

whether or not they will have the coverage for it and whether

the provider will be reimbursed."

After the CDC dropped its recommendation for the COVID shot

for pregnant women and healthy children, Kaiser Permanente, a

California-based integrated health system that provides

insurance and healthcare, said it would continue to offer it

based on medical evidence. It said vaccines are part of

proactively keeping members healthy.

Both the American College of Obstetrics and Gynecology and

the American Pharmacists Association have said the removal of

the COVID vaccine recommendation for pregnant women could

threaten patient health. The APA withheld endorsement of

Kennedy's revised recommendation.

Trade group America's Health Insurance Plans, or AHIP, said

insurers will consult professional organizations like the

American Association of Physicians and the American College of

Obstetrics and Gynecologists as they decide what to cover.

ALTERNATIVE EXPERTS

Some public health and infectious disease experts have been

organizing an alternative group to advise on vaccine use,

including Michael Osterholm, director of the Center for

Infectious Disease Research and Policy who served as an adviser

to President Joe Biden on COVID-19. He said the group, the

Vaccine Integrity Project, has been meeting with insurers.

"Given the recent developments, including changes at ACIP,

we're actively monitoring a range of expert sources to guide our

approach to vaccine coverage," said Alan Cohen, chief project

officer at Buffalo, New York-based insurer Centivo, adding that

it would seek input from medical societies and "credible

coalitions like the Vaccine Integrity Project."

Former CDC vaccine adviser Dr. Finona Havers, who resigned

last week over Kennedy's changes to vaccine policy, said it will

be hard for any outside group to replicate the work of the CDC's

ACIP committee, and questioned whether insurers can be trusted

to decide on vaccine access.

A spokesperson for a national health insurer who asked to

remain anonymous told Reuters that it is too early to determine

if they would look to another group to make decisions around

vaccine policy.

Insurers aiming to keep health plan members healthy and

lessen use of medical services would likely continue covering a

yearly COVID vaccine, an independent consultant on vaccine

policy told Reuters.

For other vaccines not mandated by ACIP's immunization

schedule, insurance companies will likely weigh member

demographics and costs, the consultant said.

A vaccine administered during childhood targeting diseases

common in older adults, such as Merck's ( MRK ) shot for the

human papillomavirus that prevents certain cancers, could be

dropped from coverage, the consultant and a second health policy

expert said. But seasonal vaccines against RSV or the flu might

continue to be covered because the costs of treating the illness

present much sooner.

Glen Nowak, a former communications director for CDC's

National Immunization Program, said dropping vaccines might save

insurers some money. "But they run the risk of losing anything

they save if there are large-scale outbreaks."