A new COVID vaccine always brings questions. This year, the availability of new treatments for respiratory syncytial virus (RSV) may add more. 

Here’s what you need to know about insurance coverage, the timing of the shots and more. 

What does the COVID situation look like in Houston?  

The viral load in the city’s wastewater has been gradually decreasing, according to data from the Houston Health Department. After reaching a peak in mid-August, when the viral load was 335 percent of the baseline set in July 2020, the viral load has since dropped to 253 percent of the baseline, according to data analyzed Sept. 11 by the health department. All but two of the city’s 39 wastewater treatment plants reported a decreasing or unchanged viral load compared to the previous week.

Statewide, the weekly average of COVID hospitalizations increased from 1,448 to 1,547 during the week ending Sept. 9. 

SUMMER COVID WAVE: What to know about its severity, BA.2.86 variant and new vaccines

When should I get the COVID shot and other vaccines?

There are vaccines available this fall for three different respiratory viruses: respiratory syncytial virus (RSV), flu and COVID-19.

RSV is highly contagious and causes infections of the lungs and breathing passages for people in all age groups. It typically spreads in the fall and winter months and is estimated to cause 14,000 annual deaths nationwide among adults over 65. Older Americans have access to an RSV vaccine for the first time after the Food and Drug Administration approved shots for people at least 60 years old in May. The agency also approved in July an RSV monoclonal antibody treatment for newborns, infants, and children up to 24 months old who remain vulnerable entering their second RSV season.

The Centers for Disease Control and Prevention says eligible people can receive all three vaccines at the same time if “there are no contraindications at the time of the healthcare visit.”

Dr. Ashley Drews, system epidemiologist for Houston Methodist, however, said it could be more beneficial for older adults to receive the RSV vaccine first — cases are already spreading in the southeastern United States — and wait about two weeks before receiving the COVID and flu shots together. That pause gives the body’s immune system enough time to respond to the first shot, she said.

People have received the COVID and flu shots together for the last two years with no issues, Drews noted. There is no data yet on how all three vaccines interact, but there’s “no reason to believe it’s going to be bad,” Drews said.  

“It’s so difficult for people to get to their doctor or get into the pharmacy to get their vaccine, so there’s an advantage” to receiving all three at once, Drews said. 

Dr. Claire Bocchini, an infectious disease specialist at Texas Children’s Hospital.said it’s safe for children to receive the COVID shot together with their flu vaccine and, if eligible, the new RSV monoclonal antibody injection, nirsevimab. Texas is beginning to see an increase in flu activity, and Houston is still in the midst of a late summer/early fall COVID wave. 

“Now is the time you want to get protected against all three of these viruses,” said Bocchini. 

How is this one different from the previous shot? 

The new vaccine is considered a “monovalent” shot — as opposed to the bivalent booster released last year — because it targets a single omicron subvariant: XBB1.5. The vaccine offers better protection against more recent offshoots dominating cases in the United States, said Drews.

The new shot was also effective against BA.2.86, Moderna and Pfizer announced earlier this month. The variant recently prompted some concern because of mutations that could make it more immune evasive. But so far, the strain doesn’t appear to be making inroads in the U.S. 

According to the CDC, anyone as young as 5 years old should receive one dose of the new vaccine, at least two months after getting the last COVID shot. People who are immunocompromised may get additional doses. Children aged 6 months to 4 years should receive at least one dose of the new vaccine, but more might be necessary, depending on whether they received previous iterations of the shot. Children in that younger age group who have never been vaccinated for COVID should receive two doses of the Moderna shot and three doses of the Pfizer shot. 

Parents can find more details on the CDC’s updated vaccine recommendations here.

“The important part is for parents to recognize the vaccines do protect children from severe disease,” said Bocchini. Studies show the initial vaccine series, coupled with last year’s bivalent booster, was 80 percent effective at preventing emergency room and urgent care visits among young children. 

The FDA anticipates updating the shots once a year, like the flu vaccine, unless a “markedly more virulent” strain of COVID-19 emerges. Public health experts make these updated vaccine recommendations because they see reduced protection over time against mild and moderate disease, especially among certain populations.

Will insurance cover the new COVID vaccine?

For the most part, yes.

The Affordable Care Act requires private insurers to cover vaccines recommended by the Advisory Committee on Immunization Practices at no cost to the patient. That includes the new COVID vaccine. Only “grandfathered” health plans, which existed before the ACA was implemented, are exempt from the requirement. In 2019, 13 percent of people covered by employer-sponsored plans were still in grandfathered plans, according to the Kaiser Family Foundation. Insurance plans also may require vaccination from an in-network provider.

Medicare is required by law to cover COVID-19 vaccinations. States also must cover the vaccine for people in the Medicaid program through September 30, 2024, after which the federal government will stop matching state expenses on vaccine doses and administration.  

Uninsured patients, as well as adults whose health insurance does not cover all COVID vaccine costs, can receive the vaccine for free through the Centers for Disease Control and Prevention’s Bridge Access Program, which partners with federally supported health centers, local health departments and many local pharmacies. CVS, Walgreen’s and eTrueNorth are participating in the program. 

Does insurance cover the new RSV vaccine, monoclonal antibody injection? 

Insurance coverage around the new RSV treatment is murkier than that of COVID. 

Medicare Part D covers the shot, but some private health plans do not. Older adults have been charged more than $300 out of pocket for the cost of the vaccine, according to the New York Times.

The monoclonal treatment will be included in the Vaccines for Children program, which provides recommended vaccines and immunizations at no cost to about half of the nation’s children. However, private insurance covers the treatment, which costs up to $495, on a case-by-case basis, said Bocchini.  The American Academy of Pediatrics has called for a more comprehensive strategy to ensure more equitable access to nirsevimab. 

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