The rollout of updated COVID-19 vaccines across the United States this September has been anything but straightforward. From North Carolina to Wisconsin, Maine to Massachusetts, the patchwork of state laws, federal guidance, and pharmacy policies has left millions of Americans scratching their heads about who is eligible for a booster, where they can get one, and whether their insurance will foot the bill. The confusion stems from a combination of new federal restrictions, a lack of timely recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP), and a variety of state-level responses—some more proactive than others.
At the heart of the issue is the Food and Drug Administration’s late August approval of new COVID-19 vaccines from Pfizer, Moderna, and Novavax. This year, the FDA’s green light was more selective than in previous years, limiting eligibility to adults 65 and older and younger people with at least one high-risk health condition such as asthma, obesity, diabetes, or even being physically inactive, according to the Associated Press and USA Today. This marked a significant shift from prior years, when nearly everyone over six months old could get the shot.
Health and Human Services Secretary Robert F. Kennedy Jr. has played a pivotal role in this change, having dropped vaccine recommendations for healthy children and pregnant women in May and replaced the entire ACIP panel with some vaccine skeptics in June, as reported by USA Today. Kennedy told a Senate committee last week that access to the new shots now "depends on the states," highlighting the decentralized and sometimes chaotic approach to public health in the U.S.
In North Carolina, the Department of Health and Human Services is "closely monitoring" changes in federal guidelines, spokesperson Summer Tonizzo told NC Newsline. However, state law currently limits pharmacists to administering vaccines only when recommended by ACIP. Because ACIP has not yet issued recommendations for COVID-19 vaccines this season, North Carolinians can only get the new booster from a pharmacist if they are 18 or older and have a prescription. This has left many pharmacists and providers anxiously awaiting the outcome of ACIP’s meeting scheduled for September 18 and 19, 2025, a delay that has real-world consequences for vaccine access.
Some states, however, are not waiting for the federal go-ahead. According to NC Newsline, at least five states have made the shots widely available without waiting for ACIP guidance. Massachusetts has gone even further, openly breaking with federal restrictions and offering COVID-19 boosters to anyone who wants them. But even there, the process is not seamless. At Bird’s Hill Pharmacy in Needham, pharmacist Kevin Ryan explained to local reporters, "We’ve been told by Moderna that we’ll get the vaccine when we get it," underscoring supply chain uncertainties. Governor Maura Healey announced that the state is working to ensure vaccines are both available and covered by insurance, but as of September 9, residents were unable to schedule appointments online under the new policy.
In Maine, the situation is equally complex. The FDA’s approval of the new vaccines applies only to those over 65 or individuals with a health condition that increases COVID-19 risk. Eligible conditions, according to the CDC, include heart disease, asthma, diabetes, pregnancy, and mental health disorders. Yet, as of September 9, anyone in Maine seeking a COVID-19 vaccine must obtain a prescription, and walk-in vaccinations at pharmacies remain off-limits until ACIP issues its recommendations. Amelia Arnold, legislative liaison of the Maine Pharmacy Association, voiced her concerns to NEWS CENTER Maine: "I think we’re in for a lot of hurt as a health care community with the burden of all of this, of having to track down prescriptions, of turning people away. But I also think that we’re gonna have a lot of really sick people in Maine, where our vaccination numbers will really suffer if we don’t get this access issue fixed." Governor Janet Mills has stated she is working with the attorney general’s office to clarify legal measures to improve access and protect providers from liability, and expects to act on regulations within the week.
Wisconsin, by contrast, has made the process a bit easier. There, pharmacies like CVS and Walgreens are offering the vaccine without a prescription to eligible individuals—those 65 and older or younger people with at least one underlying high-risk condition. When scheduling online, customers simply attest to having one of the listed conditions, which range from diabetes and obesity to simply being "physically inactive." No proof is required, and neither pharmacy asks customers to specify which condition applies. For those who don’t meet the eligibility criteria, Walgreens advises speaking with a healthcare provider about getting a prescription for off-label use.
Yet, even in states where access is relatively straightforward, insurance coverage remains a major question mark. Most health insurance plans are required to fully cover vaccines recommended by the CDC or ACIP, but as of early September, ACIP had not issued its guidance on the new COVID-19 vaccines. This means that some people may have to pay out-of-pocket if they are not included in the new recommendations, a situation that disproportionately affects those who are uninsured or underinsured. As USA Today and KFF note, private insurers also consider recommendations from organizations like the American Academy of Family Physicians when deciding what vaccines to cover.
For those living in states with stricter pharmacy laws, the barriers are even higher. In North Carolina and Maine, for example, the lack of ACIP recommendations means that COVID-19 vaccines are only available from pharmacists to those with a prescription. As CVS officials told WRAL News, pharmacists can currently vaccinate in 38 of 50 states, but in places like North Carolina, Maine, and a handful of others, prescriptions are still required unless states take additional action to authorize pharmacy dispensing prior to ACIP recommendations.
The result, as described by Jeff Jenks, medical director with Durham County’s Department of Public Health, is widespread anxiety and uncertainty. "A lot of people are kind of on the edge of their seats trying to figure out, you know, what’s going to happen this fall with the COVID-19 vaccine," he told WRAL. Jenks emphasized that the CDC’s list of high-risk conditions is extensive, and that the county’s goal is to make vaccine access as easy as possible. "Not everyone has a primary care physician, or is able to get in to see them in a timely manner, or may work multiple jobs where going in and seeing their doctor during normal business hours is not possible. So, you definitely would introduce some challenges."
As Americans wait for ACIP’s September 18 and 19 meeting, the landscape for COVID-19 vaccination remains fragmented and fraught with obstacles. State officials, pharmacists, and healthcare providers are all working to adapt to rapidly changing guidelines and to ensure that as many people as possible can access the protection they need. But for now, the path to a fall COVID-19 vaccine booster is anything but clear-cut—and for many, the wait continues.
