Dr. Dominick DeFelice practices family and sports medicine with Novant Health, he said this fall’s vaccine policy has been unclear.
“It's unfortunately still a bit of an open question, even for us on the provider side of things, we certainly have years now of data and available vaccines that Covid shots themselves are safe for those six months and older,” he said.
It mainly comes down to what the Centers for Disease Control recommends, but it hasn't issued anything yet.
“If a decision making body says, ‘Well, we recommend only 18 to 65, but the data says six months and up, are insurance companies then going to say, ‘Let's stick with the Food and Drug Administration and the bench research that says six months,’ or ‘Are we going to go with the governing body that says 18 and up?’ And really, that's a big question, because a lot of times these shots can be expensive, and if insurance companies aren't going to cover it, many people won't get it,” he said.
County health departments in the Cape Fear region told WHQR that they were waiting on the latest meeting of the Advisory Committee on Immunization Practices. The group met and issued its guidance late last week — but it didn’t do much to clear up the confusion.
“This new ACIP recommendation, making it basically an open forum, patient has to talk with his or her physician or healthcare provider, throws into question whether or not those shots are actually going to be covered unless there is a pre-existing condition,” DeFelice said.
This means that physicians are left guessing what insurance companies will do. When WHQR called around to local pharmacies, it appears that most large insurance companies are still covering it, but that could shift when the CDC unveils its official guidance. DeFelice describes what he's been hearing.
“I've heard people, in the middle age range, with no major health issues, I sent it over, and they get it, and it's covered, no problem. I've heard pharmacies, and I guess it's different, based on that patient's individual insurance plan, they've had to attest to having some chronic illness, that's a qualifier to get it covered. Otherwise, it would not have been covered. So I've heard the gamut, and I think it's just because we're in the information-gathering phase. And everything is still changing,” he said.
DeFelice said aside from the Covid vaccine, recommending what’s right for the patient versus what it will cost is a common issue for him and his colleagues.
“If I see someone in the office for problem X, I write for drug Y. I actually don't know if it's in their insurance company's formulary. I can send it to the pharmacy, and it costs the patient nothing, or I could send it in, then it costs them $1,200. That's something we actually deal with every day,” he said.
As of earlier this week, in North Carolina, those aged 18-65 can get a shot at a pharmacy if they have a pre-existing health condition or a prescription from their doctor. For those aged 6 months to 18 years, official guidance has not been set. If a person is 65 and older, then they can get one without a prescription.
Dr. DeFelice is still recommending that those 6 months and older get a Covid shot if they can.
“I think a lot of primary care doctors, family medicine pediatricians, we are in general agreement that the data behind these vaccines is very good, that they are safe and effective for those six months and up, but we may be handcuffed by these other groups weighing in with other thoughts on who is an eligible person to get vaccinated that then may influence insurance companies formularies and sort of willingness to pay,” he said.
The Covid vaccine has proven more efficacious than the seasonal flu vaccine, which is around 50%, and it can, according to DeFelice, “Prevent complications in yourself, [and] can help prevent community level spread, the more people that get vaccinated.”
Caress Clegg, a spokesperson for Novant Health, said all 10 of Novant’s primary care health clinics are offering the Covid vaccine, meaning if a patient and a physician decide the vaccine is best for them, they can get it.
Alex Riley, a spokesperson for New Hanover County, wrote that the health department will be receiving the most current version of the Covid vaccine; however, “there has not been an official arrival date to Health and Human Services.” He added he didn’t have information on potential costs for the shot.
Like DeFelice, Riley wrote that the New Hanover County Health Department is awaiting further guidance from the CDC and the North Carolina Department of Health and Human Services.
Meagan Kascsak, a spokesperson for Brunswick County, wrote that the health department plans to have the updated 2025-2026 Covid vaccine. She added they’re hoping to receive those supplies in October.
Kascsak said its the county’s understanding that, at pharmacies, patients can “self-attest to any underlying condition that puts them at high-risk for severe COVID-19. According to a press release issued on Sept. 12, 2025, people wishing to receive a COVID-19 vaccine from a pharmacy should be prepared to answer a few simple questions, like how old you are or whether you have a qualifying condition.”
WHQR reached out to Pender County’s Health Director Carolyn Moser and Wilmington Health to see about Covid-19 vaccine availability, but has yet to hear back.
Resources/Updates
