We are writing to inform you of several changes to the Vaccines for Children (VFC) program policies that may affect your practice, effective July 1, 2025. These updates pertain to the COVID-19 vaccine recommendations, RSV monoclonal antibody products, private stock vaccine requirements and the definition of underinsured. Please review the information below and reach out with any questions.
COVID-19 Vaccine Stock
Following the Centers for Disease Control and Prevention (CDC) release of updated Child, Adolescent, and Adult Immunization Schedules with revised COVID-19 vaccine recommendations, new VFC policies will take effect July 1, 2025. Private providers enrolled in the VFC Program will no longer be required to routinely stock COVID-19 vaccines. However, they must be able to refer VFC-eligible children to a safety net provider, such as a Local Health Department (LHD), if needed as part of their routine vaccine management plan. LHDs should continue to maintain at least the minimum ordering quantity of state-supplied VFC COVID-19 vaccines to serve this role. While no longer required, providers are strongly encouraged to continue stocking and administering COVID-19 vaccines to protect their patients. Ensuring access in primary care settings promotes timely vaccination and prevents missed opportunities.
Providers who do not stock the COVID-19 vaccine are expected to be aware of and prepared to refer patients to locations known to stock the vaccine, similar to procedures for non-routine VFC vaccines like mpox and PPSV23. To support continuity of care, it is important to confirm that the provider receiving referrals is equipped and ready to provide the necessary additional immunizations.
Private Stock and VFC Vaccines
Starting July 1, 2025, CDC will no longer require VFC providers to maintain a full stock of all privately purchased ACIP-recommended vaccines for non-VFC-eligible patients if they do not plan to offer all ACIP-recommended vaccines to this population. This guidance pertains to all ACIP-recommended products, including RSV monoclonal antibody products. Providers that serve and plan to vaccinate privately insured, non-VFC eligible population, must continue to maintain a separate vaccine inventory to vaccinate their non-VFC-eligible population.
If a VFC provider does not carry private stock, they are not permitted to use VFC stock on non-VFC-eligible patients. Routine borrowing and replacement of VFC vaccines and monoclonal antibody products for use among privately insured, non-VFC-eligible patients will not be permitted.
RSV Monoclonal Antibody Products
All VFC-enrolled providers that serve VFC-eligible children 19 months of age or younger are required to carry VFC-supplied RSV monoclonal antibody products at the start of RSV season, which typically begins October 1. We anticipate ordering will open prior to the start of RSV season and will provide further guidance on the ordering process soon.
Updated Definition of Underinsured
The definition of "underinsured" for VFC-eligible patients has been updated:
- A person under age 19 is now considered underinsured if:
- Their insurance does not cover any ACIP-recommended vaccines,
- Their insurance covers only some ACIP-recommended vaccines, or
- Their insurance does not provide first-dollar coverage (i.e., vaccine coverage is subject to copays, coinsurance, or deductibles).
- Their insurance does not cover any ACIP-recommended vaccines,
Note: As a reminder, underinsured children are eligible to receive VFC vaccine only through a Federally Qualified Health Center (FQHC), a Rural Health Clinic (RHC), a Local Health Department (LHD), or a private provider with an approved deputization agreement. All other providers should refer underinsured children to one of these facilities in order to receive VFC supplied vaccines.
Patients must be screened for eligibility at each immunization encounter, so before administering a vaccine, providers must verify whether the child’s health insurance plan covers ACIP-recommended vaccine. For underinsured children, whose medical home is not with a FQHC, RHC, or LHD, the provider should notify the parent /guardian that the patient is VFC eligible and could receive VFC vaccines at one of these designated provider types.
If the parent/guardian chooses to receive vaccines for their child at their non-deputized medical home, the patient would receive private purchased vaccine and would be financially responsible for the cost of the purchased vaccine and the associated administration fees.
Birth dose hepatitis B policy for enrolled hospitals
To ensure we are consistent with CDC’s 317 funding policy and recent clarifications from CDC, we are no longer allowing universal administration of the birth dose hepatitis B vaccine to infants using state supplied vaccines, starting July 1, 2025. Beginning July 1, 2025, birthing hospitals must screen infants to determine eligibility and use the appropriate vaccine stock (state supplied VFC, state supplied 317, or hospital privately purchased).
This policy applies only to birth dose hepatitis B vaccines administered prior to hospital discharge. RSV immunizations are not affected; state-supplied RSV vaccines have never been universally available and remain limited to VFC-eligible patients only. Due to this change, private providers may begin seeing more children who did not receive the hepatitis B birth dose in the hospital.
Thank you for your attention to these policy changes. Updates to the VFC coverage criteria will be forthcoming to align with recent changes. We will continue to monitor the immunization landscape and communicate any future updates to VFC policies as they become available.
How to contact us:
For assistance, please contact the NCIP Help Desk by phone at 1.877.USE.NCIR (1-877-873-6247) or by email.
Thank you for your ongoing partnership and dedication to improving immunization outcomes in North Carolina.
In Health,
NC Department of Health and Human Services