Americans have started rolling up their sleeves for the latest version of the COVID-19 vaccine, but weeks into the rollout some say they are still having difficulty finding appointments for themselves and their children.

Shot seekers also say they have been surprised by requests for upfront payments of $150 to $200 now that the U.S. government has handed off to private companies including vaccine makers, pharmacies, and insurance plans to handle distribution, administration and payment coverage.

Many Americans have been eager to get vaccinated after COVID-19 cases picked up in much of the country in September.

Around 4 million people received the updated Pfizer (PFE.N)/BioNTech (22UAy.DE) or Moderna (MRNA.O) shots in September, and 12 million doses were shipped, according to data from the U.S. Department of Health and Human Services (HHS). The U.S. government has recommended all Americans ages 6 months and older receive one.

Kate MacDowell, a self employed 50-year-old who lives in Portland, Oregon, said she had a vaccine appointment canceled by her healthcare provider, Kaiser Permanente, and has been unable to get another for nearly a month. She and her husband canceled a trip overseas in late September in part because they could not find the shots.

“It used to be that even if it was scarce you could find somewhere that you could drive to get it,” said MacDowell. “You have the federal government or the county health department saying go get your vaccine, and it’s just impossible.”

Kaiser did not comment on MacDowell’s experience in Oregon. The multi-state healthcare provider, target of a 3-day strike by 75,000 workers this week, said it does not cover out of network vaccinations except in California, where by law members can get reimbursed for COVID-19 vaccines from non-Kaiser providers including retail pharmacies until Nov. 11.

The U.S. government in May ended the COVID public health emergency declaration during which it bought the shots and provided them to all Americans for free.

In the current privatized system, health insurance plans by law must cover the shots at no cost. Pharmacies and health providers order the shots upfront from manufacturers and receive their supply from distributors.

Pfizer and Moderna say they have shipped the shots as planned.

At the beginning of last week, Pfizer said it had shipped and delivered more than 10 million doses of its 2023-2024 COVID-19 vaccine, including more than 1 million pediatric doses. Moderna has also said it has shipped millions of doses.

CVS (CVS.N), the largest U.S. pharmacy chain, said on Thursday it was still experiencing delivery delays from its wholesalers.

Walmart (WMT.N) said it is offering updated COVID shots in all stores as supply becomes available. Walgreens, a unit of Walgreens Boots Alliance (WBA.O), said all stores now have the supply needed to meet demand in their communities.

McKesson (MCK.N), one of the largest U.S. wholesalers, said it has distributed over 3.8 million shots so far. It acknowledged a need to ramp up across the supply chain, saying that may have impacted delivery dates for some customers.

“We are working diligently to turn COVID-19 inventory as quickly as it is received and are growing our fulfillment of orders daily,” a spokesperson said.

Cardinal Health (CAH.N), another major distributor, said it also shipped several million COVID-19 vaccines “with some minor and short-term shipping delays.”

PHARMACIES PAY UPFRONT TOO
After widespread reports of payment refusals early in the campaign, health insurance executives met with government officials on Sept. 27 and said plans are reimbursing vaccines given by in-network providers.

“Health insurance providers continue to educate Americans about where and how to get their COVID vaccines within their plan’s coverage,” David Allen, a spokesperson for insurance lobby group AHIP said.

Still, some people told Reuters they are being told at pharmacies where they got COVID shots previously that the new ones are not covered by their plan at that location.

Independent pharmacists are facing a different issue. Now that the government is no longer footing the bill for their vaccine supply, pharmacy owners need to pay for the shots.

“I was hesitant to order as much as I knew I would need right out of the gate because they also had some restrictions on their return policy,” said David Kohll of Kohll’s Pharmacy, which has six locations in Nebraska. “That made me pull the reins back a little bit.”

An HHS spokesperson said the department “has engaged closely on these issues, even with the transition to the commercial market.”

Some people told Reuters their insurer instructed them to pay upfront and seek reimbursement if their pharmacies asked for payment.

James Daily, a 43-year-old software developer from Readington, New Jersey, paid close to $600 last month to get shots for himself, his wife and his oldest daughter, and said he’s had trouble finding an appointment for his 4-year old daughter.

State regulations on vaccine administration for young children vary.

Dr. Suzanne Berman, a pediatrician in Crossville, Tennessee, said she was concerned about losing money.

“Demand has really slacked off, so I don’t want to buy a lot of product that’s going to go to waste,” she said. “If it expires or goes bad then I’ve sunk money without any return on it.”