Protecting Seniors Through Immunizations
By Reps. Donna E. Shalala (D-FL), Phil Roe, M.D. (R-TN), Ann McLane Kuster (D-NH), and Larry Bucshon M.D. (R-IN)
The Hill
OPINION CONTRIBUTORS — 03/30/20 01:00 PM EDT

As our health care and public health emergency preparedness systems rush to contain, treat and prevent coronavirus, we need to consider how longstanding structural flaws in our vaccine policies have hindered our nation’s disease prevention efforts and put older adults and persons with serious chronic conditions needlessly at risk.

Picture this scene. A woman, age 50, decides to take her father, age 80, to the pharmacy so they can get their vaccines together. The woman has insurance through her work, while her father is on Medicare. Before they get their shots to keep them safe, the pharmacy tech rings them up and tells the woman that her vaccine is completely covered with no co-pay. The tech then tells her father that he has a co-pay of $80, because under Medicare, beneficiaries can still incur some out-of-pocket costs for recommended vaccines. Does this make any sense?

No. But we have a plan to fix it.

Before vaccines, nearly everyone got measles. Diseases like whooping cough, polio, and rubella were commonplace among children and adults. Today, though, vaccines are one of the main reasons we live longer and healthier lives. However, not everyone can afford to take advantage of this monumental public health achievement. Each year more than 50,000 adults in the United States die from vaccine-preventable diseases, and millions more become ill.

Ten thousand Americans turn 65 every day, which means the number of Medicare beneficiaries who need easy access to vaccines is constantly increasing. 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.

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 $15 billion treating Medicare beneficiaries alone for four vaccine-preventable diseases (Flu, Pneumococcal, Shingles, Pertussis). Cost-sharing and co-pays for vaccinations recommended by the Center for Disease Control and Prevention Advisory Committee on Immunization Practices were removed for all Affordable Care Act compliant private plans in 2010; however, Medicare beneficiaries were left out of this change and can still face high out-of-pocket costs for vaccinations.

We don’t believe older adults should pay more than other Americans for vaccines that help prevent the spread of contagious diseases and keep us all safe. This is why we introduced the Protecting Seniors Through Immunization Act: to eliminate out-of-pocket costs for vaccines to everyone under Medicare. Currently, Medicare vaccine coverage is split between Medicare Part B (which covers physician services, outpatient services, certain home health services, and durable medical equipment) and Medicare Part D (which covers drugs). Seniors can access vaccines covered under Part B—such as flu, pneumonia and Hepatitis—with no out-of-pocket costs. However, under Part D, vaccines such as shingles (herpes zoster) and pertussis (Tdap) often include a cost to beneficiaries.

For seniors, many of whom live on fixed incomes, these 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.

In addition to removing cost-sharing for vaccines under Medicare Part D, the Protecting Seniors Through Immunization Act updates the vaccine information used to guide seniors in the national Medicare handbook. The bill also authorizes a study to understand how we can reduce racial and socio-economic differences in vaccination rates, as well as understand the administrative burden faced by providers.

Scientists are working overtime to bring new vaccines to market for emerging threats like coronavirus and a host of other preventable diseases—but their efforts will be less effective if the gaps in our current vaccine policies remain. Congress needs to make sure these innovations are accessible to and affordable for all Americans—regardless of whether they are insured by the private marketplace or Medicare Part D.

As scientists like to say: vaccines cause adults. We say: let’s make sure they cause seniors, too.

Shalala represents Florida’s 27th District and is former HHS secretary, Roe represents Tennessee’s 1st District and is a member of the House GOP Doctors Caucus, Kuster represents New Hampshire’s 2nd District, and Bucshon represents Indiana’s 8th District and is a member of the Energy and Commerce Health Subcommittee. He is also a member of the House GOP Doctors Caucus.