CVS and Walgreens, the country’s two largest pharmacy chains, are for now clamping down on offering Covid vaccines in more than a dozen states, even to people who meet newly restricted criteria from the Food and Drug Administration.
On Thursday, Amy Thibault, a spokeswoman for CVS, said the vaccine was not available at pharmacies in 16 states, citing “the current regulatory environment” and emphasizing that the list could change.
On Friday, CVS issued an update: It could administer vaccines in 13 of the 16 states, and in the District of Columbia, to people who had obtained a prescription from a doctor or other medical provider. (As of Friday morning, its online scheduling tool still did not allow anybody to book an appointment in those places; Ms. Thibault said an update was in progress.) In Massachusetts, Nevada and New Mexico, CVS still cannot offer the shots at all, Ms. Thibault said.
She did not provide an explanation for the change.
Walgreens did not respond to requests for information. But when a New York Times reporter tried to schedule vaccine appointments in all 50 states, the Walgreens website said patients would need a prescription in 16 of them. Though there is some overlap, it’s not the same set of 16 as CVS, underscoring the level of confusion.
The shifting requirements for vaccines have fueled deep uncertainty about whether — and where — Americans can access the shots.
Health Secretary Robert F. Kennedy Jr. has long condemned Covid vaccines and has made a number of false claims about their safety and utility, which has already complicated this year’s vaccine rollout. Under his leadership, health agencies have issued confusing guidance about Covid vaccines, narrowed the eligibility criteria for the shots and replaced members of the C.D.C.’s vaccine committee with people who have objected to Covid vaccines, sowing chaos.
Requiring prescriptions for the shots is a total change in practice, said Dr. Marc Sala, a co-director of the Northwestern Medicine Comprehensive Covid-19 Center in Chicago.
Legal experts said that federal decisions were creating an extremely difficult situation for pharmacies to navigate. The biggest problem is that in some states, the law prohibits pharmacists from administering vaccines that are not recommended by the Advisory Committee on Immunization Practices, a Centers for Disease Control and Prevention panel.
Last year, the panel voted to recommend updated Covid vaccines in June. In 2023, it endorsed new Covid vaccines in September, just one day after the F.D.A. gave its approval.
But as of this Thursday, the panel was not scheduled to meet for another three weeks. And, after a slew of high-level resignations at the C.D.C., Senator Bill Cassidy — Republican of Louisiana and the chairman of the Senate’s health committee — has called for the meeting to be “indefinitely” postponed. That could mean many people’s access to shots will remain hamstrung well into the fall, when infections from respiratory viruses normally spike.
CVS will make the vaccines readily available nationwide if the advisory panel recommends them, Ms. Thibault said. (In the 34 states where the company hasn’t set limits, people can simply check a box when they make an appointment online to attest that they meet the F.D.A. criteria, without a prescription or other documentation.) But since the panel hasn’t yet made a decision, the company is holding back in states where it believes its pharmacists need a C.D.C. endorsement.
The states where CVS is requiring a prescription are Arizona, Colorado, Florida, Georgia, Kentucky, Louisiana, Maine, New York, North Carolina, Pennsylvania, Utah, Virginia and West Virginia, along with the District of Columbia, according to Ms. Thibault.
Based on The Times’s attempts to book appointments, Walgreens appears to require prescriptions in Arizona, Colorado, Georgia, Indiana, Louisiana, Missouri, Montana, New Mexico, New York, Oregon, South Carolina, Utah, Virginia, Washington State, West Virginia and Wisconsin. In many states, appointments were unavailable, but it was not clear whether that was because of state laws or a lack of immediate vaccine supply.
Pharmacies have traditionally been a crucial access route to the Covid vaccine, accounting for a vast majority of shots given last year. The CVS and Walgreens moves are strong signals that federal decisions could reduce access more than the restrictions laid out on paper — not everyone has access to a doctor to obtain a prescription, for example. The confusion is likely to crop up at other pharmacies as well, legal experts said.
Experts are themselves divided on what pharmacies can do, but they agree that the choices are hard.
Whether last year’s C.D.C. recommendation on Covid shots still applies is ambiguous, said Richard Hughes IV, a vaccine lawyer who teaches at George Washington University Law School and worked for Moderna early in the pandemic. There is an argument that it does still apply, and that pharmacists can administer the updated vaccines under it unless ACIP says otherwise, he said.
But Richard Dang, an associate professor of clinical pharmacy at the University of Southern California, said he believed the reformulated shots required a new recommendation.
CVS and Walgreens appear to have judged that their pharmacists can perform the actual injections in the states where they are requiring prescriptions, but can’t determine the appropriateness of a vaccine for a particular patient. Those questions are legally separate, Mr. Hughes said.
The prescription requirements “may be pharmacies covering themselves while all of these unanswered questions are still up in the air,” said Dr. Shira Doron, the chief infection control officer for Tufts Medicine.
Covid vaccination rates have fallen precipitously since the height of the pandemic. Just 23 percent of adults and 13 percent of children reported getting an updated Covid vaccine last season.
The fact that pharmacies are limiting access to vaccines when Covid infections are rising, as they do every summer, is “really unconscionable,” said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco.
Making it more difficult to schedule a shot may discourage even more people from getting vaccinated, doctors said.
“It’s just raising more and more barriers,” Dr. Chin-Hong said. “It’s like an obstacle course.”
He added: “I don’t know anybody who’s not confused.”
Maggie Astor covers the intersection of health and politics for The Times.
Dani Blum is a health reporter for The Times.
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