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Supporting access to vaccines for Part D beneficiaries

Tom Wilbur   |     August 12, 2020   |   SHARE THIS

Today, in honor of National Immunization Awareness Month, we’ll take a look at how Medicare Part D supports access to critical vaccines and strengthens public health. Vaccines represent some of the most impactful advances in public health, helping to prevent the spread of many infectious diseases. Here in the United States, there are currently 16 diseases that are now preventable as a result of childhood vaccines.

A recent report found that there are nearly 260 vaccines in development by America’s biopharmaceutical companies, including dozens for COVID-19 in the pipeline. Biopharmaceutical companies are exploring a wide range of approaches to COVID-19 for older adults including increasing the doses or adding a booster to the shot. Yet no matter the approach, biopharmaceutical researchers must comply with a number of regulations throughout the development process to help ensure vaccine safety.

Continued progress in the research and development of new vaccines is important news for Americans of all ages, but especially for seniors. It is important for adults and seniors to receive certain vaccinations as they age to avoid a variety of serious conditions. The immune system naturally weakens over a patient’s lifespan and vaccines can be critical to prevent illness among the elderly, who may be particularly vulnerable to infection. For example, shingles is caused by the same virus that causes chickenpox (varicella-zoster) and can occur in adults who had chickenpox as children. It is thought that lowered immunity to infections as people grow older may be the cause.

Ensuring greater uptake of and access to vaccines will improve public health and reduce broader health care costs over time. Increasing awareness of the availability and value of vaccines, particularly among adults, can help improve vaccine rates. It is also important to provide robust insurance coverage for preventative care more broadly, including vaccines, in order to avoid vaccine-preventable diseases.

Low adult immunization rates are due to multiple barriers, including lack of information about recommended vaccines, financial hurdles, as well as technological and logistical obstacles.

For medically necessary, commercially available adult vaccines not covered under Medicare Part B, Part D covers available vaccines and, since 2012, the Centers for Medicare & Medicaid Services (CMS) has encouraged Part D plans to offer either $0 or low-cost sharing for vaccines to help increase adult immunization rates. Despite this encouragement, Part D plans continue to apply cost-sharing for vaccines that may limit access for beneficiaries. This effort to ensure vaccines are affordable and accessible to seniors is critical as illnesses attributed to vaccine-preventable diseases remains higher in adults than children.

While the biopharmaceutical works to ensure a safe and effective vaccine for COVID-19 is successful, patients of all ages, including older adults should consult with their health care provider about the appropriate vaccines to prevent against infectious diseases, including the annual influenza vaccine.

Learn more about the importance of vaccinations here. Learn more about how Medicare protects public health and improves access to needed vaccines and treatments, by following along with our new Catalyst series on Medicare Part D.

Tom Wilbur

Tom Wilbur is Director of Public Affairs at PhRMA focusing on federal advocacy priorities including Medicare and intellectual property. Prior to joining PhRMA, Tom worked in politics and on Capitol Hill, most recently responsible for communications and strategy for U.S. Rep. Fred Upton and the House Energy and Commerce Committee. Tom is a proud Michigander and outside of the office enjoys reading, running, hiking, golfing, live music, and spending time with family and friends.

Topics: Vaccines, Part D, Medicare

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