Gov. Ned Lamont on Wednesday issued a slew of executive actions seeking to protect COVID-19 vaccine access in Connecticut amid recent federal changes that are causing confusion over who’s eligible for shots, where people can get them and how much they’re going to cost.
Last month, the U.S. Food and Drug Administration limited its approval of updated boosters to people 65 and older, as well as those with underlying health conditions that put them at risk of severe outcomes from COVID-19. As a result, access to the booster for anyone who falls outside those categories has been in flux.
But the executive actions announced today by the Lamont administration buck the federal changes.
The state’s Department of Public Health is encouraging children 6 months and older, as well as adults of all ages, to get vaccinated. Guidance issued by the Department of Consumer Protection seeks to facilitate access to the boosters at local pharmacies, and a bulletin from the Connecticut Insurance Department guarantees coverage of the shots for certain residents.
“As uncertainty in Washington continues, our administration is doing everything we can to ensure the residents of Connecticut have access to the health care they need to stay safe,” Lamont stated in a Wednesday press release.
Here’s what you need to know.
Who can get a booster in Connecticut?
On Aug. 27, the U.S. Food and Drug Administration, under the leadership of the Health and Human Services Secretary Robert F. Kennedy Jr., approved the 2025-2026 COVID-19 vaccine for people over the age of 65 as well as anyone with an underlying health condition that puts them at risk for severe outcomes from the virus.
The announcement upended guidance from the past several years that allowed anyone 6 months or older to get the vaccine.
The state’s Department of Public Health issued interim guidance on Wednesday stating that all residents who qualify for a booster based on the FDA’s eligibility criteria, as well as children ages 6 to 23 months, “should” get the vaccine. It also directs that anyone 6 months or older, regardless of underlying health, “can” get a booster.
Guidance issued to pharmacists by the Department of Consumer Protection allows anyone who falls outside of the FDA eligibility criteria to show up at their local pharmacy and get a vaccine or make an appointment without a prescription, a spokesperson with the state’s Department of Consumer Protection confirmed.
“DCP has met with both CVS and Walgreens, as well as the National Association of Chain Drugstores (NACDS) and Walmart regarding this guidance,” the spokesperson stated in emailed comments. “Our guidance offers the ability for a person who falls outside the FDA eligibility criteria to show up at a CVS or Walgreens (or any other pharmacy) without a prescription.”
Prior to Lamont’s announcement, spokespeople with CVS and Walgreens confirmed that Connecticut residents could stop by a pharmacy or sign up to get the vaccine without a prescription if they were in the populations approved for the booster by the FDA. Patients can self-attest their eligibility, and no proof or additional documentation is required.
Those who do not qualify can still receive the vaccine with a prescription from their provider, a spokesperson with CVS confirmed.
But the CDC’s list of qualifying underlying conditions that can lead to severe COVID-19 is extensive. It includes conditions like asthma, depression and substance use disorder. People with a BMI of 25 or greater, those who are “physically inactive,” as well as anyone who is a current or former smoker, also qualify.
At a press conference on Wednesday, Lamont acknowledged that the state’s guidance conflicted with federal guidance and that it could take a couple of weeks for pharmacies to sort out.
“I’d say it’s a little tricky for a national pharmacy company to get some rulings from the feds and Health and Human Services and then different ideas from the state. They’re trying to get that balance right as well,” Lamont said.
Lamont said he’d be reluctant to use emergency powers — calling it a “last resort” — to mandate pharmacies to broadly administer the vaccine but would wait a couple of weeks to see what’s needed to ensure Connecticut residents have access to the boosters.
“If the pharmacists say, ‘That’s not enough for us because we worry about pushback from the feds,’ we’ll have to revisit that in a week or two,” he said.
The Connecticut Hospital Association applauded the state’s actions.
“These efforts are critical in supporting patients and protecting communities across the state. As we enter respiratory virus season, individuals are encouraged to protect themselves and their families from preventable infections. Vaccination remains one of the most effective tools we have to reduce illness and safeguard public health,” a CHA spokesperson stated in a press release.
How much will it cost?
Nearly all insurance carriers are required to cover vaccines at no cost if they are recommended by what’s known as the CDC’s Advisory Committee on Immunization Practices, or ACIP. ACIP’s recommendations are separate from the FDA approval issued last month. ACIP has not yet issued recommendations regarding this year’s COVID-19 vaccine.
The committee is scheduled to meet next on Sept. 18-19, at which point coverage of the boosters could become clearer. There have been instances where ACIP’s recommendations differed from the FDA’s initial approval.
In June, Kennedy came under fire for abruptly firing all 17 members of ACIP. Days later, he appointed eight members to serve on the panel, including several who had previously advocated against vaccines.
On Wednesday, Connecticut took steps to secure insurance coverage of the COVID-19 booster for certain residents, even if ACIP ends up recommending otherwise.
A bulletin issued by the Department of Insurance confirmed that coverage for COVID-19 vaccines is mandatory under Connecticut state law under all “Connecticut-issued policies, regardless of ACIP’s position.”
However, Connecticut only has jurisdiction over what are known as “fully insured” individual and small group plans, which cover roughly 250,000 people, or 8% of the state.
Many large employers have what are known as “self-funded” plans, where the employer pays for employees’ health care costs directly, instead of paying a fixed premium to an insurance carrier. Absent a recommendation by ACIP that would mandate coverage across most providers, self-funded plans would get to decide whether to cover the cost of the booster for their enrollees.
Chris DiPentima, the president of CBIA, Connecticut’s largest business group, did not directly answer a question regarding whether Connecticut’s large employers would voluntarily follow suit and cover the cost of the booster.
“Employers who use self-funded plans will adopt a holistic approach to this, considering employee health and wellness along with their overall compensation and benefits package,” DiPentima stated in emailed comments.
CT DPH recommends that anyone seeking the vaccine confirm coverage with their health plan.
Are you having difficulty scheduling a COVID-19 booster or being asked to pay for it out of pocket? If so, we want to hear from you! Email kgolvala@ctmirror.org.
This story was originally published by the Connecticut Mirror.
