Brad Gallagher, co-chair of Barclay Damon’s Health Care Controversies and Pharmacy Teams, was featured in the Corporate Counsel article “Insurers, Providers Face Newly Fragmented Vaccine Landscape” highlighting the growing patchwork of state-by-state vaccine rules following changes at the federal level. While some states are moving to broaden access, others are tightening restrictions, creating uncertainty for insurers, providers, and multi-state health care organizations.
Brad noted that New York State Governor Kathy Hochul’s recent executive order, which authorizes pharmacists to prescribe and administer COVID-19 vaccines without a doctor’s prescription, falls squarely within the authority of states, which are charged with licensing and regulating pharmacists. At the same time, he cautioned that pharmacists “still need to be vigilant” about future executive orders or legislation that might change policy.
Even where vaccine administration is authorized, Brad emphasized that reimbursement issues remain unresolved. “Even if you can give the vaccine there’s no guarantee that you’re going to get paid for it,” he said. He explained that while states may have legal authority to require insurers to cover vaccines recommended at the state level, the shifting role of the federal Advisory Committee on Immunization Practices (ACIP), which has traditionally set the national standard for vaccines covered by Medicare, Medicaid, and Affordable Care Act–subsidized plans could limit that authority and create additional ambiguity.
“The states would appear to have at least some legal authority to bind them and have them cover the cost of the vaccinations that are recommended by the state,” he said. However, ambiguity remains, which may result in compliance challenges for health care companies throughout the country.
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