Several governors issue standing orders to expand pharmacy access to COVID-19 shots amid narrower federal guidance

Several governors on Friday signed standing orders intended to ensure that most residents can receive COVID-19 vaccines at pharmacies without individual prescriptions, a move by states to broaden access as federal guidance this year limits who is broadly recommended to get the shots.

The governors of Arizona, Illinois, Maine and North Carolina joined a growing list of Democratic officials issuing orders or guidance aimed at reducing barriers to vaccination. CVS Health, the nation's largest pharmacy chain, said its stores were offering COVID-19 shots without individual prescriptions in 41 states as of midday Friday. Under CVS's interpretation of state policies, nine states and the District of Columbia still require individual prescriptions: Arizona, Florida, Georgia, Louisiana, Maine, North Carolina, Oregon, Utah and West Virginia, plus Washington, D.C. Arizona, Maine and North Carolina are likely to come off that list as their new orders take effect.

Maine Gov. Janet Mills, a Democrat, framed her standing order as a response to federal policy changes. “I will not stand idly by while the Trump Administration makes it harder for Maine people to get a vaccine that protects their health and could very well save their life,” Mills said in a statement. Arizona Gov. Katie Hobbs said her order protects "health care freedom" in the state.

The state actions come after a change in federal recommendations. In past years, federal authorities advised that COVID-19 vaccines be offered to nearly all Americans 6 months and older. This year, the U.S. Food and Drug Administration approved vaccines for people age 65 and over for broad use, but recommended their use only for children and younger adults who have qualifying risk factors such as asthma or obesity. The shift followed the dismissal in June of the federal Advisory Committee on Immunization Practices, after U.S. Health Secretary Robert F. Kennedy accused committee members of being too closely aligned with vaccine manufacturers; the committee's replacements include individuals described as vaccine skeptics.

At least 14 states announced policies this month to ease access to the shots — a group made up mostly of Democratic-led states and including Virginia, where Republican Gov. Glenn Youngkin has taken action. Some states that moved this month — such as Delaware and New Jersey earlier in the week, and Illinois on Friday — already had pharmacies that were providing the shots more broadly; officials said the governors' orders are expected to formalize or expand that access.

North Carolina's standing order differs from many others. It applies to everyone age 65 and older and to adults 18 and older who have an identified risk factor; other adults would still need individual prescriptions under the new order. State officials cautioned that while the order takes effect immediately, pharmacies might not have vaccine supplies on hand right away.

Pharmacy chains and state boards of pharmacy have been central actors as state governments respond to federal changes. Four states — California, Hawaii, Oregon and Washington — announced a multistate alliance this month to develop their own vaccine recommendations. Of those four, only Oregon did not already allow pharmacy-based vaccination without an individual prescription, according to CVS's assessment.

Most Republican-controlled states have not moved to change vaccine policy this month, and vaccinations remain available in those states under existing rules. Florida has drawn attention for a separate, more controversial set of moves: Florida's surgeon general, Dr. Joseph Ladapo, announced a plan that could make some childhood vaccinations optional. State officials later said the change likely would not take effect until December and that, without legislative action, only some vaccines such as those for chickenpox would become optional; measles and polio vaccines would remain mandatory.

State officials and pharmacy chains said the orders and policy changes are intended to prevent delays in access and to ensure that patients who want the updated COVID-19 vaccines can get them quickly at convenient locations. Public health officials have noted that the federal shift to recommending vaccines broadly only for older adults and for younger people with risk factors narrows the populations for which health agencies explicitly advise vaccination this season, creating a patchwork of state responses as governors and pharmacy regulators fill gaps.

Officials in the states issuing orders said they expect the changes to increase vaccination access immediately where supplies are available and to align pharmacy practice with the needs of older adults and people with medical risk factors. Associated Press writer Patrick Whittle in Maine contributed to reporting on the evolving state actions.