Cost-sharing for adult vaccines must be eliminated

The cost of a gallon of gas has been grabbing headlines. But what if the cost you pay wasn’t necessarily determined by where you live or world events, but instead by what kind of car you drive or how old you are?

While that may seem far-fetched, the scenario is not that different from what American adults face when figuring out the cost of being vaccinated against potentially deadly diseases. Depending on what kind of insurance coverage you have, the costs for vaccines to prevent such illnesses as pneumococcal disease, shingles and whooping cough can vary widely.

Legislation pending in Congress could take the cost, confusion, and disparities out of adult immunizations. The Protecting Seniors through Immunization Act seeks to make access more equal by eliminating financial and other barriers for vaccines as well as instituting smart strategies to educate older Americans on the topic.

To address costs, the legislation will align Medicare Part D vaccine coverage with Medicare Part B, in terms of deductibles, coinsurance, annual out-of-pocket cost spending thresholds, and coverage limits.

Currently, vaccines covered under Medicare Part D can have varying copay requirements. Costs can be passed on to patients in the form of a set copay or as coinsurance. Under Part D, nearly 24 million beneficiaries in stand-alone prescription drug plans are subject to cost-sharing requirements ranging from $14 to $103 per vaccine.

On the flip side, vaccines covered under Medicare Part B, like flu and pneumococcal disease, require no out-of-pocket costs for patients. It’s not a surprise that seniors are more likely to opt for vaccines with no cost-sharing than those for which they must pay.

Keeping adult immunization rates high is critically important. Older adults are more susceptible to communicable diseases due to weakening immune systems. Like the rest of our bodies, the immune system ages, but vaccines offer protection to ward off diseases that can land patients in the hospital with long-term health impacts or even be fatal.

This is not a new problem. Even before the pandemic, it was estimated that at least 50,000 adults die each year of preventable diseases, and unvaccinated adults cost the health care system billions of dollars a year.

In addition to addressing cost disparities, the bill also will help with vaccine education and outreach to older Americans. As the past year has shown, getting information from trusted sources is critically important to continue to raise vaccination rates. Additionally, the legislation provides for investigating ways to reduce racial and socio-economic disparities and strengthening immunization information reporting systems.

Far too many seniors have fallen behind on their routine vaccinations over the course of the pandemic, and all these strategies will be critical to getting those rates back up and to increase them among this vulnerable population. Estimates show that 75% of adults are missing one or more critical vaccines.

As an organization that works to support, enable and empower people to live fully as they age, we know the key role that preventative health measures like vaccines play in the lives of older Americans.

As the U.S. population continues to age, having smart policies in place that encourage vaccine uptake will be critical to the country’s future public health.

Prioritizing fairness and awareness of the critical role vaccines play in the long-term health of our seniors is more important now than ever.

This guest essay reflects the views of Diane Darbyshire, vice president of advocacy and public policy at LeadingAge New York.