AVAC Urges the Biden Administration to use its Presidential Budget to Tackle Vaccination Barriers

AVAC members offered comments on the need for the Biden Administration to address financial burdens brought about by vaccines, particularly those for adults, by allocating the necessary funds in its Build Back Better Recovery Plan.

Dear President Biden 

As our nation undergoes a vaccination program that will be the greatest public health efforts of our generation, members of the Adult Vaccine Access Coalition (AVAC) and stakeholder partners ask that as you consider updating longstanding structural flaws in our vaccine policies as part of the Build Back Better Recovery plan. Inequities in coverage of vaccines across public and private programs, particularly for adults, has hindered our nation’s disease prevention efforts and put older adults and persons with chronic conditions needlessly at risk and is critical to expanding access to preventative health care services. 

Section 2713 of the Public Health Service Act (PHS Act) added by the Patient Protection and Affordable Care Act (ACA) removed cost-sharing and co-pays for vaccinations recommended by the Center for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) for all compliant private plans. However, Medicare and some Medicaid beneficiaries were left out of this change and still face high out-of-pocket costs for vaccinations. Financial barriers to all ACIP recommended vaccines must be eliminated for individuals covered by Medicaid and Medicare to improve the underlying health of the communities most at risk for COVID-19 and aid the elimination of racial disparities in health care. A fully vaccinated public is an investment in our future health, wellbeing and economic success of our national. Eliminating financial barriers thus is imperative and we urge you to tackle this issue in the President’s forthcoming Budget Proposal by including budget proposals that would remedy this disparity. 

Immunizations are a cornerstone of our nation’s disease prevention efforts and have a demonstrated track record of success as a cost-effective means of reducing disease burden and saving lives. Despite the well-known benefits of immunization, adult coverage lags behind federal targets for most commonly recommended vaccines: influenza, pneumococcal, tetanus, hepatitis B, herpes zoster, and HPV. Millions more adults suffer from vaccine-preventable diseases, causing them to miss work and leaving some unable to care for those who depend on them. Adults seeking access to and coverage for vaccines encounter multiple barriers, including lack of awareness and information about recommended vaccines, financial hurdles including high-cost sharing, as well as technological and logistical obstacles. Improving adult access to vaccines can save thousands of lives and billions of dollars. The health care costs associated with low adult vaccine rates are high—each year, the U.S. spends $26.5 billion treating four vaccine-preventable diseases (Flu, Pneumococcal, Shingles, Pertussis).


Vaccines are particularly important for older adults because our immune systems weaken with time. Adults age 50 and over are particularly susceptible to many vaccine-preventable diseases and account for a disproportionate number of the deaths and illnesses they cause. This is why older adults are most at risk of developing severe illness from coronavirus. For older adults, many of whom live on fixed incomes, additional costs may delay or even prevent them from getting vaccinated. A 2018 study of Tdap and herpes zoster vaccine claims under Medicare Part D demonstrated that when the costs of vaccines are high, seniors can’t or won’t get them. The study found that costs of $51 or more to the beneficiary are associated with a greater rate of cancelled vaccination claims compared to beneficiaries with no out-of-pocket costs. We ask that you include the Protecting Seniors Through Immunization Act2, bicameral, bipartisan legislation which would ensure all vaccines under Medicare are available to beneficiaries with no cost sharing or deductibles as part of your budget proposal to Congress. The bill brings parity between out-pocket costs between Medicare Part B and Medicare Part D. 


Currently, access to vaccines under Medicaid varies, depending on where live and your Medicaid eligibility status. Medicaid enrollees who are covered through Medicaid expansion programs are guaranteed access to all vaccines ACIP-recommended by the with no cost sharing requirements. By contrast, not all vaccines recommended for adults are covered by traditional Medicaid programs and those that are covered may have cost sharing requirements that put access to the vaccine out of reach. We must fix disparities in coverage in the Medicaid program by providing a baseline of consistent and reliable Medicaid coverage across the country. Medicaid covers low-income older adults, persons with disabilities and chronic conditions, and pregnant women. Many of these same populations have been hit hard by the COVID-19 pandemic. These high-risk groups are also extremely vulnerable to serious adverse health consequences of other vaccine preventable illnesses. We ask that you also include in the budget the Helping Adults Protect Immunity (HAPI) Act3, which would ensure that all Medicaid enrollees have access to this important preventive health service and do not face insurmountable financial hurdles when a recommended vaccine provides a clear and direct health benefit. 

As our country continues to work to meet the challenges of the pandemic, now is the time to redouble our efforts to eliminate the underlying vaccination disparities that have been prevalent in our health care system for too long. Our organizations are available to answer your questions at your earliest convenience. Please reach out to AVAC Managers Abby Bownas, (abownas@nvgllc.com) or Lisa Foster (lfoster@nvgllc.com). 

American Academy of Family Physicians 
American Lung Association 
American Public Health Association 
Families Fighting Flu 
Hepatitis B Foundation/Hep B United 
Immunization Action Coalition 
National Association of Nutrition and Aging Services Programs 
National Consumers League 
National Hispanic Medical Association 
National Minority Quality Forum 
STChealth LLC 
The AIDS Institute 
The Gerontological Society of America 
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