CurrentSharp-Health-PlanPolicy N/A

AB 144 — Coverage of Preventive Immunizations (commercial plans)

Governs Sharp Health Plan coverage of preventive immunizations for commercial plan members in California, implementing AB 144 and covering vaccines recommended by federal bodies as of Jan 1, 2025 and CDPH supplements.

Policy Summary

PayerSharp-Health-Plan

PolicyCoverage of preventive immunizations under AB 144 (commercial members)

Policy CodePolicy N/A

Change TypeNew coverage per state law

Effective DateSep 17, 2025

Next Review DateN/A

Key ActionAdminister COVID-19, influenza, and RSV immunizations to eligible commercial members without prior authorization or cost-sharing per the age/risk group chart.

SourceLink

POLICY UPDATE CHANGES

Sharp Health Plan will cover immunizations for commercial plan members based on AB 144 and recommendations in effect on January 1, 2025.

COVID-19, influenza, and RSV immunizations will be covered without cost-sharing or prior authorization for all age groups according to specified risk/age group criteria.

Plan will continue coverage even if USPSTF, ACIP, or HRSA removes or downgrades recommendations.

If CDPH publishes updated recommendations, the Plan will cover modifications within 15 business days.

Sept 17, 2025AB 144 effective

Jan 1, 2025Federal reference date

15 daysCDPH adoption timeline

Policy Summary

PayerSharp-Health-Plan

PolicyCoverage of preventive immunizations under AB 144 (commercial members)

Policy CodePolicy N/A

Change TypeNew coverage per state law

Effective DateSep 17, 2025

Next Review DateN/A

Key ActionAdminister COVID-19, influenza, and RSV immunizations to eligible commercial members without prior authorization or cost-sharing per the age/risk group chart.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria for Preventive Immunizations

Covered preventive immunizations

Covered when ANY of the following policy sources/recommendations apply:

Federal recommendation sources (USPSTF/ACIP/HRSA): Immunizations recommended by the U.S. Preventive Services Task Force with an A or B rating in effect on January 1, 2025; immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) and/or the Health Resources and Services Administration (HRSA) in effect on January 1, 2025; and the recommended childhood immunization schedule jointly adopted as of January 1, 2025 by the American Academy of Pediatrics, ACIP, and the American Academy of Family Physicians are covered.

Per AB 144, the Plan will continue to cover these services even if USPSTF, ACIP, or HRSA later removes or downgrades recommendations.

CDPH supplementation: If the California Department of Public Health (CDPH) publishes updated recommendations, Sharp Health Plan will cover the modifications or supplements within 15 business days of such updated recommendations.15 business days

Plan adoption timeline for CDPH updates is specified in the alert.

Vaccine-specific age/risk coverage: COVID-19, influenza, and RSV immunizations are covered without cost-sharing or prior authorization for the age and risk groups listed in the provider alert (see chart), including but not limited to: children (COVID-19: 6–23 months; 2–18 years with risk factors or never vaccinated; influenza: ≥6 months; RSV: younger than 8 months and 8–19 months with risk factors), pregnancy (COVID-19 and influenza for those planning pregnancy, pregnant, postpartum, or lactating; RSV for 32–36 weeks gestational age), and adults (COVID-19: ≥65 years and younger adults with risk factors; influenza: all adults; RSV: ≥75 years and 50–74 years with risk factors).

Specific groupings and details are enumerated in the provider alert.

Coverage under this policy does not apply to Sharp Health Plan members enrolled in the Federal Employees Benefits Program (FEHB) or in Medicare Advantage benefit plans. The guidance and vaccine coverage described in this alert are limited to Sharp Health Plan commercial members and do not change benefits for FEHB or Medicare Advantage enrollees.

Provider Actions and Billing/Authorization Requirements

Prior Authorization

Prior Authorization Not Required

No prior authorization required — COVID-19, influenza, and RSV immunizations are covered without prior authorization for all age groups.

Applies to COVID-19, influenza, and RSV immunizations.
Coverage applies across all age groups per AB 144/Sharp Health Plan guidance.

Step Therapy

No step therapy requirements specified in this alert.

Documentation Required

Documentation Requirements

Documentation practices — Providers should follow standard documentation practices; no additional documentation requirements are specified in this alert.

Definitions and Scope of Covered Immunizations

Immunizations recommended by ACIP/HRSA or with A/B USPSTF rating as of Jan 1, 2025

USPSTF A/B preventive servicesEvidence-based items or services with an 'A' or 'B' rating from the U.S. Preventive Services Task Force in effect on January 1, 2025.

ACIP/HRSA immunizationsImmunizations recommended by the Advisory Committee on Immunization Practices (ACIP) and/or the Health Resources and Services Administration (HRSA) in effect as of January 1, 2025.

Recommended childhood immunization scheduleThe childhood immunization schedule jointly adopted as of January 1, 2025 by the American Academy of Pediatrics, ACIP, and the American Academy of Family Physicians.

Plan continuation after downgradesSharp Health Plan will continue to cover these services even if USPSTF, ACIP, or HRSA later removes or downgrades recommendations.

CDPH updatesIf the California Department of Public Health publishes updated recommendations, the Plan will cover modifications or supplements within 15 business days of such updates.

Background and Legislative Context

AB 144 directs Sharp Health Plan to cover preventive immunizations that are supported by federal recommendations in effect on January 1, 2025. Specifically, covered items include services with a USPSTF rating of A or B in effect on that date, immunizations recommended by ACIP and/or HRSA as of January 1, 2025, and the childhood immunization schedule jointly adopted by the American Academy of Pediatrics, ACIP, and the American Academy of Family Physicians as of that date. The law also requires the Plan to continue coverage even if USPSTF, ACIP, or HRSA later remove or downgrade recommendations, and to adopt any California Department of Public Health (CDPH) updates within 15 business days of publication.