HHS/CDC Bridge Access Program

First, according to HHS, provide support for the existing public sector vaccine safety net, which is implemented through local health departments (LHDs) and Health Resources and Services Administration (HRSA) supported health centers.

• This combination of partners has historically been a key source of care for people without health insurance and has been at the forefront of this Administration’s response to COVID-19.

• Under the Program, the Centers for Disease Control and Prevention (CDC) will use its existing authority under Section 317 of the Public Health Service (PHS) Act to purchase and distribute COVID-19 vaccines and allocate them through its network of 64 state and local health department immunization awardees across the nation. These awardees will then distribute vaccines to LHDs and participating HRSA-supported health centers.
• Under the Program, HRSA will also provide support directly to its networks of health centers to support delivery of both vaccines and treatments.
• This structure builds on decades of experience and success in similar efforts through the Vaccines for Children program and Section 317-funded immunization programs.
• The Program is also consistent with the President’s Budgets for Fiscal Years (FYs) 2023 and 2024, which propose a permanent Vaccines for Adults (VFA) program, but this proposal has not yet been enacted into law. The proposed VFA program will provide permanent access to vaccines recommended for adults and would create a permanent solution to the existing gaps in access. However, since this program has yet to be enacted by Congress, a temporary solution is needed to prevent loss of access to COVID-19 vaccines and treatments for uninsured adults.
• As in those existing efforts, the Federal government will receive a discount for the purchase of these COVID-19 products, consistent with longstanding policy related to these and other similar Federal purchasing programs. 

Vaccines for Adults (VFA) Program

The Bridge Access Program serves as a “temporary bridge” and is scheduled to end in December 31, 2024, according to HHS. A longer-term solution is the Vaccines for Adults (VFA) program, proposed in both the FY 2023 and 2024 Presidential Budgets, which would create a permanent initiative modeled after the successful Vaccines for Children (VFC) program, and would cover all recommended vaccinations at no cost for uninsured adults. This proposal has not yet been enacted into law. 

Second, according to HHS, create a novel, funded partnership with pharmacy chains that will enable them to continue offering free COVID-19 vaccinations and treatments to the uninsured through their network or retail locations as has been done during the COVID-19 Public Health Emergency (PHE).

• Pharmacies have been a critical partner in the Administration’s response to COVID-19 and a critical access point for millions of Americans in receiving convenient and timely COVID-19 vaccines, treatments, and tests. This Program will also leverage the public commitments by drug manufacturers to provide vaccines and treatments, such as Paxlovid, free-of-charge for the uninsured. During the 2022-2023 season, available data show that more than two-thirds of adult COVID-19 vaccinations were administered at pharmacies.
• While COVID-19 vaccine manufacturers have committed to provide vaccines at no cost for the uninsured, thus far, the details of how this commitment would be fulfilled has not been fully clear.
• In announcing this Program, HHS aims to support that commitment from manufacturers and ensure that the pharmacy setting remains a place of access for the uninsured.
• In building the Program, CDC will establish contracts with pharmacies to enable them to continue offering COVID-19 vaccines and designated treatments with no out-of-pocket costs to uninsured individuals, maintaining this critical access point for this population.
• Specifically, the Program will provide a per-dose payment to pharmacies in order to facilitate the administration of any COVID-19 vaccines and treatments at pharmacies that will be made available, relying on vaccine manufacturers' public and private commitments to provide COVID-19 vaccines at no cost for uninsured people.
• In return for alleviating manufacturers of this administrative burden and the expense of working directly with pharmacies, HHS expects that manufacturers ensure vaccines will be made readily available directly to pharmacies that participate in this effort and that manufacturers’ patient assistance programs will provide appropriate reimbursement or replacement for COVID-19 vaccines.
• Under these agreements, pharmacies will also be eligible for one-time base payments for each site targeting areas with low rates of access and low rates of vaccination. 
• As part of the Program, participating pharmacies will be expected to ensure appropriate oversight, including via patient attestations regarding lack of insurance coverage, and by providing CDC with periodic facility level data, at the direction of CDC.
• The pharmacies will also be expected to conduct outreach regarding the availability of the COVID-19 vaccine, including through community partnerships with a focus on underserved populations. 
• Additionally, these contracts will also allow uninsured individuals to receive access to certain COVID-19 treatments, including the drugs Paxlovid and Lagevrio, from participating pharmacies with no out-of-pocket costs.
• Over the next few months, HHS will establish new contractional relationships with pharmacies, so that this component of the program could be launched sometime this Fall. The goal is to include not only large pharmacy chains, but also smaller, local chains and independently owned pharmacies.