Hochul Executive Order Seeks to Maintain Access to COVID Vaccine

(Sept. 8, 2025) Governor Hochul issued an executive order (EO No. 52) on Sept. 5^th, authorizing physicians, nurse practitioners, and pharmacists to order and/or administer the 2025-2026 COVID vaccine, consistent with Department of Health (DOH) guidance. The EO was issued in order to maintain access to the COVID vaccine, in light of the recent Food and Drug Administration (FDA) approvals of the 2025-2026 COVID vaccines and the absence of recommendations by the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP). The FDA approvals narrowed the approved uses of the vaccine to individuals age 65 years or older and individuals under age 65 who are at risk for serious complications related to COVID infection. As a result of the FDA determinations, individuals under age 65 without an underlying high-risk condition require an off-label, patient-specific prescription and could experience difficulty accessing the vaccine. Moreover, in the absence of ACIP recommendations, the authority for pharmacists to administer the vaccines to any patients, under NYS Education Law, was unclear.

Under prior FDA approvals, consumers were able to access the COVID vaccine at a pharmacy without a specific doctor's order. The EO is intended to preserve access to vaccines for all New Yorkers at their local pharmacy through non-patient-specific orders, by authorizing:

physicians and nurse practitioners to order patient-specific or non-patient-specific orders to pharmacists to administer the vaccine to patients age 3 and older;
pharmacists to administer the vaccines to individuals age 3 and older pursuant to a non-patient-specific or patient-specific order; and
pharmacists to prescribe and order a patient-specific order for immunizations to prevent COVID for patients 3 years of age or older.

All of the authorities in the EO are subject to guidance issued by the Commissioner of Health. The Commissioner's guidance documents recommend vaccination against COVID for all adults age 19 and older; all children age 6-23 months; children ages 2-18 with certain high-risk conditions or living situations; and all pregnant, postpartum, and lactating persons. According to the guidance, children ages 2-18 who do not meet the high-risk indications may be vaccinated against COVID at the request of their parent or guardian.

Further, the Commissioner's guidance documents authorize:

physicians and nurse practitioners to issue non-patient-specific standing orders for COVID vaccination for people who meet the FDA indications for 2025-2026 products;
physicians and nurse practitioners to administer the vaccine to individuals consistent with “off-label” use, by a patient-specific order; and
pharmacists to write patient-specific orders for off-label uses of COVID immunizations and administer the vaccine pursuant to those orders.

In addition to issuing the above guidance, the Commissioner issued a non-patient-specific standing order to pharmacists for the Moderna COVID vaccine (2025-2026 formula) for persons 3 years and older consistent with the FDA approval and the recommendations of the CDC's ACIP.

The availability of the COVID vaccine for individuals under age 64 who lack a high-risk underlying condition is significant for individuals who work in long-term care and aging services and the people they serve. Moreover, nursing homes and adult care facilities (ACFs) are required by regulation to offer the COVID vaccine to residents and staff within specified time frames. LeadingAge NY has reached out to DOH seeking clarification on the permissibility of physician and nurse practitioner issuance of non-patient-specific orders for off-label uses.

The administration of the vaccine is also in question due to a delay in publication of updated CDC guidance. The latest available CDC guidance pertains to the 2024-2025 vaccines and is available here. LeadingAge National has reached out to the Centers for Medicare and Medicaid Services (CMS) for direction on nursing home compliance with its vaccination regulations, given the absence of updated CDC guidance, but did not receive a clear response. As reported in several news outlets, changes in the CDC's policy on the vaccine have led to the resignations of the CDC director and several members of its leadership. The CDC's ACIP is scheduled to meet on Sept. 18^th to discuss the COVID vaccine recommendations.

The FDA approvals for the 2025-2026 vaccines are here, here, here, and here.

The Commissioner's guidance on the COVID vaccine is available at the following links:

LeadingAge NY will keep members apprised of new developments as they emerge.

Contact: Karen Lipson, klipson@leadingageny.org