The state this week told health insurers they must fully cover, without patient cost-sharing, the cost of COVID-19 vaccines in New Jersey for the 2025-2026 respiratory illness season and authorized pharmacists to administer the vaccines without prescription.
New Jersey joins a growing number of states that are breaking with a new federal policy that limits access to COVID-19 vaccines to people who are 65 and older and restricts access to younger people unless they have an underlying health condition, such as asthma, putting them at greater risk of severe illness without a COVID booster shot.
U.S. Health and Human Services Secretary Robert Kennedy Jr. announced the major shift in vaccine policy on social media Aug. 27, saying the U.S. Food and Drug Administration had approved updated COVID-19 booster shots for the fall, but only for certain groups.
That prompted the New Jersey acting Health Commissioner Jeffrey Brown to issue an executive directive a week later stating that, based on the scientific evidence, his department was still recommending people over the age of 6 months to be vaccinated.
In an effort to clear up confusion about insurance coverage for vaccines in the wake of the FDA decision, the New Jersey Department of Banking and Insurance (DOBI) issued a bulletin Thursday telling carriers that it expects them to continue fully covering the cost of vaccinations, without patient cost-sharing, for anyone 6 months of age or older.
The state Department of Health also issued a separate standing order on Sept. 8 to pharmacists authorizing them to continue providing COVID-19 vaccinations and booster to anyone over the age of 3 without a prescription. (Children between the age of 6 months and 36 months would get their vaccinations from their pediatrician’s office).
“New Jersey is committed to ensuring access to the COVID-19 vaccine for all who want one,” DOBI Commissioner Justin Zimmerman said Thursday. “The Department expects that carriers will continue to cover the vaccine for New Jersey residents without cost sharing and is strongly encouraging carriers do so without imposing additional barriers.”
DOBI has also directed insurance carriers to update plan documents, as needed, and make clear in all online information how people may access covered benefits for vaccinations. Carriers acting as administrators for non-state regulated plans are expected to encourage plan sponsors to take steps that are consistent with DOBI’s bulletin.
