AVAC believes that Americans should be able to receive all recommended vaccines at no cost.

All individuals under 65 with commercial health insurance coverage do not have to pay for their ACIP-recommended vaccines. However, older adults and some adults with Medicaid coverage face a complicated and costly landscape when it comes to vaccine access. When Americans have to pay for their vaccines they are less likely to be vaccinated. This doesn’t just harm the individual but is harmful at the community level. AVAC is committed to policy changes to provide Americans with all recommended vaccines at no cost in Medicare and Medicaid.

Medicare

For older adults, some vaccines are covered under Part D drug plans and others are covered by Part B.  Medicare Part B covers vaccinations to protect against influenza, pneumococcal, and hepatitis B at no cost. Medicare Part D covers all other CDC recommended vaccines, including those for shingles (Zoster), whooping cough (TDAP), and future vaccines, that cost beneficiaries anywhere from $0 to $160.

Patient makes a pharmacy purchase

Our pharmacists encourage seniors to get their recommended vaccines. Unfortunately, far too often we see seniors decide not to get vaccinated because of a higher copay that their Part D health plans require at the pharmacy.

Mitch Rothholz
American Pharmacists Association (APhA)

Medicaid

People with Medicaid can also face varying costs for vaccines depending on their state. Under the Affordable Care Act (ACA), states that expanded Medicaid have access to recommended vaccines at no cost.  However, in non-expansion states, people with Medicaid have to pay for the same recommended vaccines.

AVAC and ALA Co-Host an Improving Access to Vaccines in Medicaid Webinar

On March 24, AVAC and the American Lung Association co-hosted a virtual Congressional briefing on the importance of vaccines recommended by the Centers for Disease Control and Prevention (CDC), the barriers to accessing these vaccines that exist for the traditional Medicaid population, and new legislation that can improve the health of our nation and increase health equity by addressing this coverage gap.

Doctor or nurse gives flu vaccine to patient at clinic.

What can Congress and the Administration Do?

1. Expand first dollar coverage of vaccines to Medicare Part D, enhance provider billing for Part D vaccines, and improve vaccine information and education for beneficiaries.

2. Work with CMS to encourage Medicare Advantage and stand-alone Prescription Drug Plans (MA-PD) to include immunizations in the zero-cost sharing vaccine tier.

Example: Shingles

Cost is a barrier to improved immunization rates. A study on factors associated with abandonment of the shingles vaccine was published in the July/August 2016 American Journal of Pharmacy Benefits. Abandonment is defined as “a patient not receiving the vaccine despite evidence of an initiated fill.” Of the 172,977 initiated fills included in the study, 67,369 were abandoned, an overall abandonment rate of 38.9 percent. Rates varied by patient demographics and health plan characteristics but patient cost sharing was a significant predictor after adjusting for other factors.

Join our call to eliminate out-of-pocket costs for vaccines in Medicare Part D.

Vaccines play an essential role in preventing disease, helping to keep older adults healthy, active, and independent. Join over 100 organizations in urging Congress to pass the Protecting Seniors Through Immunization Act. This important bipartisan bill will not only eliminate out-of-pocket costs for vaccines covered under Medicare Part D, but will also ensure that beneficiaries receive important information about the benefits of immunizations.

Older mother laughing with her two daughters

AVAC Supports the Introduction of the Protecting Seniors Through Immunization Act

On March 23, Senators Hirono, Capito, Whitehouse, and Scott introduced the bipartisan Protecting Seniors Through Immunization Act of 2021. The bill would reduce financial barriers by providing Medicare coverage of CDC-recommended adult vaccines with no additional cost-sharing for beneficiaries; improve patient education by including information about vaccine coverage in the Medicare & You Handbook; and require a study on vaccine uptake among Medicare beneficiaries.

Senior adult man and home healthcare nurse.

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