Payers should cover COVID-19 vaccines for all ages and risk groups with no patient cost sharing.

The COVID-19 vaccine saved millions of lives during the pandemic. Clinical trials at the time of authorization and approval showed remarkable effectiveness. However, the effectiveness of the COVID-19 vaccine has changed now that people are no longer naive to the virus. The benefit of vaccination is incrementally lower for some people, raising questions about who should receive the vaccine, what the vaccines should cost, and which subpopulations would be cost-effective to vaccinate. The Institute for Clinical and Economic Review (ICER) recently released its assessment of the COVID-19 vaccine. It was ICER's first vaccine assessment, presumably because of the uncertainty of future coverage policies for the COVID-19 vaccine. ICER found that the COVID-19 vaccine is most beneficial for the very young, the very old, and those in between with risk factors. Cost-effectiveness models mirror effectiveness assessments. Limiting vaccine access to people with risk factors in specific age bands would require a prior authorization, adding complexity and administrative costs for payers. Coverage restrictions may further reduce population vaccinations rates, resulting in higher virus community load and prolonged circulation. Although the US regulatory framework requires insurers to cover vaccines included on the Centers for Disease Control and Prevention (CDC) Immunization Schedules without cost sharing, the future placement of COVID-19 vaccines on these schedules is uncertain. Given the evidence and population benefits, we support ICER's recommendation for private payers to cover COVID-19 vaccines with no patient cost sharing. We further recommend no restrictions on coverage based on risk factors, regardless of CDC Immunization Schedules, which have recently been subject to considerable uncertainty.