The Journal Gazette
Wednesday, August 25, 2021 1:00 am

Eliminating vaccine copays boost for more than just seniors

Dawn Moore

If you were offered $100 to get a vaccine – one that was proven to safely prevent serious diseases and has been used for many years – you probably wouldn't need much convincing.

This is a trend we've seen happening more and more to encourage people to get vaccinated against COVID-19. Meanwhile, when it comes to other CDC-recommended vaccines, some Americans are having to reach into their own pockets to receive the immunizations they need to protect their health and well-being, especially at a time when we should be doing everything we can to strengthen our immune systems.

Many Americans who receive their health insurance through Medicare Part D face significant out-of-pocket costs when they go to receive a shingles, Tdap or other CDC-recommended vaccine. Given that Medicare Part D is intended for some of our population's most vulnerable, at-risk individuals – seniors and those with disabilities – we should think twice about any barriers to receiving these lifesaving immunizations.

Fortunately, Congress can do something about it this year and help ensure more Indiana seniors have access to the immunizations they need.

The Protecting Seniors Through Immunization Act would eliminate out-of-pocket costs for vaccines covered under Medicare Part D and increase access to vaccines, such as shingles and Tdap. This legislation would not only boost immunization rates among seniors but would also help prevent the spread of these diseases among others, including family members.

Furthermore, the act would perform an important public health service by increasing education and awareness of the vaccines recommended for adults and seniors. All this will ensure more people are receiving the vaccines they need to stay safe and healthy.

Most individuals enrolled in a commercial plan or Medicare Part B pay nothing for vaccines recommended by the Centers for Disease Control and Prevention. Unfortunately, Medicare Part D covers vaccines in a very different manner that too often dissuades seniors from getting vaccinated.

For instance, a Tdap vaccine to protect a parent and the new baby in their family from whooping cough can have out-of-pocket costs surpassing $100. The cost-sharing practices patients face under Medicare Part D are a major burden for important preventive medical care.

Our seniors should be prioritized for immunizations, not discouraged from getting them, particularly as COVID-19 cases are again on the rise. Adults 50 and older account for a disproportionate number of vaccine-preventable deaths and illnesses. And until we eliminate the financial barrier of high out-of-pocket costs, this population will continue to fall behind in receiving these lifesaving vaccines.

Because Medicare Part B requires no out-of-pocket costs for its covered vaccines, we see higher immunization rates among Part B beneficiaries. Meanwhile, immunization rates are much lower among Part D beneficiaries who have to pay for their vaccines.

A study on factors associated with abandonment – a patient requesting the vaccine then not getting it – of the shingles vaccine, published in the July/August 2016 American Journal of Pharmacy Benefits, showed that of the 172,977 initiated fills included in the study, 67,369 were abandoned, an overall abandonment rate of 38.9%. Patient cost-sharing was noted as a significant predictor.

The evidence is clear, and we must do something about it. Older adults are dealing with weakening immune systems, and vaccines can help to prevent serious illnesses and improve quality of life.

The reality is that our country's aging population has become increasingly susceptible to vaccine-preventable diseases as a result of their financial inability to receive lifesaving vaccines. The Protecting Seniors Through Immunization Act would remove the cost barrier and increase immunizations while providing educational resources for these individuals to make informed decisions about their health.

I encourage Indiana's senators and representatives to support this important act and ensure vaccine accessibility for all Hoosiers.

Dawn Moore is president of the Indiana Pharmacists Association.

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