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Preparing for the 2026-2027 respiratory virus season

August 13, 2026
 

Read the August formulary update

As employers prepare for the upcoming respiratory virus season, several updates to influenza (flu), Coronavirus disease 2019 (COVID-19), and respiratory syncytial virus (RSV) vaccine recommendations may affect benefit planning. While some recommendations have evolved, the overall goal remains the same: ensuring members have access to evidence-based preventive care while minimizing disruption to coverage. A series of procedural shifts at the federal level, along with active legal challenges, has created a rare disconnect between official federal recommendations and the clinical “best practices” advocated by major, independent medical societies like the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

To manage utilization, maintain compliance, and avoid member disruption, here is the streamlined state of play for the upcoming flu, COVID-19, and RSV season.

 

Influenza: The “Thimerosal-Free” Dilemma

The Advisory Committee on Immunization Practices (ACIP) has recommended that for this season, children, pregnant individuals, and all adults receive only single-dose, thimerosal-free formulations of the flu vaccine.

  • The Federal Rationale: Single-dose prefilled syringes are natively preservative-free and emphasizing them aligns with long-term goals of minimizing mercury-based preservatives.
  • The Clinical Counterpoint: Major medical groups, including the AAFP, have expressed logistical concerns regarding a strict thimerosal-free preference. Many local family clinics still rely on multi-dose vials (which contain trace thimerosal as a preservative) to manage high patient volumes and avoid supply bottlenecks.

 

COVID-19: Divergent Universal Recommendations

The most pronounced divergence between federal guidelines and major medical associations centers on who should routinely receive the updated COVID-19 vaccine (updated to target the JN.1-lineage).

  • Federal Strategy: Recent updates to the federal vaccine schedule moved COVID-19 vaccines for healthy individuals under age 65 into a “shared clinical decision-making” (SCDM) framework rather than a routine universal recommendation.
  • Medical Association Best Practice: Independent bodies like the AAP and AAFP have explicitly broken away from this downgrading. Their current schedules strongly recommend routine, universal vaccination for all infants aged 6 to 23 months, pregnant individuals, and anyone in high-risk categories. They also continue to recommend the vaccine for any child or adult “desiring protection.”

 

RSV: Simplified Risk-Tiers & Pediatric Expansion

Fortunately, there is solid, unified alignment between federal agencies and independent medical associations regarding RSV protocols. Keep in mind that adult RSV vaccines are not annual; if a member received one in a prior season, they do not need another.

  • Adult Tiers (Ages 50–74): Aligning with both federal and clinical associations, RSV vaccines can be given to seniors aged 75+ years of age universally, and ages 50–74 on a risk-stratified basis (e.g., those with chronic heart/lung diseases or advanced diabetes).
  • Pediatric Expansion: To prevent supply chain bottlenecks during peak winter months, Premera covers both available infant monoclonal antibody options: Nirsevimab (Beyfortus) and the newer, fixed-dose clesrovimab (Enflonsia). Both the CDC and pediatric societies recommend either product with no preference.

 

Premera remains committed to supporting vaccines as an essential part of preventive care. We continue to cover recommended preventive vaccines, including COVID-19 and influenza vaccines, consistent with evidence-based medical guidance and applicable federal and state requirements. Our approach is guided by recommendations from public health and clinical experts, including the Advisory Committee on Immunization Practices (ACIP), and we will continue to monitor evolving guidance to ensure our members have access to recommended preventive services. As always, members should consult with their healthcare providers to determine which vaccinations are appropriate for their individual health needs.

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