Vaccine Access Frequently Asked Questions 

1. How do vaccines get approved and become available to patients? 

• In the U.S., the Food and Drug Administration (FDA) evaluates the safety and efficacy of vaccines before approving or authorizing them. 
• Following FDA review, the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) provides recommendations for use in various populations, including high-risk groups. 
• State governments, pharmacists and insurance companies often use these ACIP recommendations to determine how and to whom vaccines are administered. 

2. What are the updated CDC/ACIP recommendations for the COVID-19 vaccine in 2025?

• No prescription requirement: ACIP rejected a proposal that would have required prescriptions for COVID-19 vaccines, ensuring broader pharmacy access.
• Adults 65 and older: Vaccination choice should be based on decisions made by individuals with their health care providers, also known as shared clinical decision making.
• Individuals aged 6 months to 64 years: Vaccination decisions should be based on personal risk. The CDC emphasizes that those at higher risk for severe COVID-19, such as those with underlying health conditions, stand to benefit most.

3. What do changing state vaccine policies mean for me? 

State policies can affect: 

• Eligibility: Who may receive certain vaccines. 
• Access points: Where you can get vaccines (such as clinics, pharmacies or schools). 
• Insurance coverage: For example, Massachusetts requires insurers to cover state-backed vaccines, even without CDC support. 
• Prescription requirements: Some vaccines may need a doctor’s note in certain states. 
• Public health messaging: Conflicting rules create confusion about which vaccines to get, and when and where to get them. 
• School and workplace mandates: Ending mandates increases the risk of exposure for immunocompromised people, including those with arthritis. 

4. What is the new CDC/ACIP vaccine recommendation for MMRV?

ACIP decided that the MMRV vaccine (measles, mumps, rubella and varicella) should no longer be recommended or covered by the Vaccines for Children program. As a result, the MMRV shot will not be paid for by government insurance.

• Children under 4 will still be eligible for separate MMR and varicella shots, which should continue to be covered.

5. Do any provider groups have vaccine recommendations?

Yes. The American Academy of Family Physicians, American Academy of Pediatrics and the American College of Obstetricians and Gynecology have all released recommendations for vaccine recommendations. 

In addition, the American College of Rheumatology has listed its recommendations. 

6. How do I know if I can get the COVID or flu vaccine from my pharmacist or provider? 

• Please check your state health department’s website for updated information about vaccine access. 
• Currently, five states have taken regulatory action to ensure access to COVID vaccines from pharmacists: 
  • Colorado: The State Board of Pharmacy adopted an amendment that gives pharmacists authority to provide treatment “that is based on national, evidence-based published guidance.” That section of law also gives pharmacists authority to administer vaccines pursuant to a standing order issued by the Colorado Department of Public Health and Environment’s chief medical officer. 
  • Massachusetts: Issued new regulations requiring insurers to cover vaccines recommended by the state’s Department of Public Health, even if the CDC hasn’t acted yet. 
  • New Mexico: Following new regulatory action by the New Mexico Department of Health, pharmacists can prescribe and administer COVID-19 vaccines using state health department guidelines instead of waiting for federal recommendations. 
  • New York: The governor signed an executive order that allows pharmacists to administer COVID vaccines, providing access for all New Yorkers who wish to be vaccinated. 
  • Pennsylvania: The State Board of Pharmacy voted to allow Pennsylvania pharmacists to follow vaccine recommendations from trusted authorities, including the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP) and the FDA, instead of waiting for the Advisory Committee on Immunization Practices to act. 

7. How do I know if my state is passing laws or policies in response to current federal vaccine policies? 

• Websites like the Infectious Disease Prevention Network tracks state vaccine legislation.  

8. What if my insurance won’t cover the vaccine? 

• Typically, private insurers must cover recommended vaccines without a copay, but current inconsistencies may lead to delays or denials. 
• Steps if coverage is denied: 
  • Ask your doctor to provide documentation of immunosuppression. 
  • Appeal the denial with your insurance company. Call our Helpline for assistance: 800-283-7800. 

9. Why do school and community vaccination requirements matter? 

• Children with juvenile arthritis or adults on immunosuppressive therapy often rely on population immunity to protect them from exposure. 
• High community vaccination rates are crucial for protecting immunocompromised individuals. 
• Supporting science-based school mandates and opposing efforts to end vaccine requirements helps prevent outbreaks and protect immunocompromised individuals.