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 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 new FDA COVID-19 vaccine guidelines for 2025, and how could they impact people with arthritis? 

• The FDA’s 2025 guidance limits the updated COVID-19 shots to people 65 and older and those with certain high-risk or underlying conditions. 
• Notably, CDC’s list of underlying conditions that qualify someone for the COVID vaccination includes the "use of corticosteroids or other immunosuppressive medications." For people with arthritis, this would include medications like prednisone as well as disease-modifying antirheumatic drugs (DMARDs), including biologics medications.  
• Previously, vaccines were available to anyone 6 months and older. 
• The change limiting them to people 65 and older and those with underlying conditions may: 
  • Delay access for adults under 65 and children with arthritis who are not explicitly named. 
  • Cause confusion at pharmacies, as some may refuse to vaccinate without explicit federal guidance. 
  • Introduce insurance coverage uncertainty, as some insurers tie coverage to FDA and ACIP guidance. 

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. Are vaccines being covered in my state? 

• Some states have passed new regulations allowing pharmacies to administer vaccines without guidance from ACIP or the FDA. 
• Many states, however, cannot move forward without ACIP recommendations. ACIP is meeting Sept. 18 to begin discussing recommendations for various vaccines. 

5. Do I need a prescription to get a vaccine? 

• Non-live vaccines (including flu shots — not the nasal spray, COVID-19, shingles and pneumonia) are often available at pharmacies without a prescription. 
• HOWEVER, due to new FDA guidance, access to COVID vaccines may require a prescription for those who don’t meet eligibility criteria, including those under 65. 
• Having documentation from your rheumatologist may help pharmacies or clinics provide the vaccine with fewer obstacles. 

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.