Letter to The Honorable Seema Verma, Administrator for the Centers for Medicare & Medicaid Services - Daines Urges Administration to Improve Access to Vaccines for Montana Seniors

Letter

Dear Administrator Verma,
Immunizations are one of the greatest medical advances in human history. Vaccines have
essentially eradicated deadly and debilitating conditions, such as measles, chickenpox, polio, that
were once commonplace. As the current COVID-19 pandemic rages on around the globe,
researchers are racing to find a vaccine to protect and prevent further morbidity and mortality as a
result of this novel virus. Older adults and persons with chronic conditions such as heart disease,
diabetes and lung disease are especially vulnerable to serious illness and complications from
vaccine preventable disease. Yet, Medicare coverage design for vaccines for these populations
does not encourage access to this proven and cost-effective form of prevention. We urge the
Centers for Medicare and Medicaid Services (CMS) to take action to address this important issue.
As you know, immunization coverage for Medicare beneficiaries is segmented between
Medicare Part B, which covers vaccinations against influenza, pneumococcal and hepatitis B for
at-risk patients and Medicare Part D, which covers all other commercially available vaccines
when deemed medically necessary to prevent illness. While beneficiaries receive Part B-covered
vaccines with no cost sharing, Part D vaccines are typically subject to cost sharing requirements.
The variable cost sharing requirements discourage immunization among elderly, disabled and
chronically ill populations who account for a disproportionate percentage of the morbidity and
mortality from vaccine preventable conditions.
Since 2012, the CMS Annual Call letter to Medicare Advantage and Prescription Drug
Plans has brought to light the need to strengthen beneficiary access to Part D vaccines to protect
against costly and devastating vaccine preventable conditions. The FY20 call letter stated, "In an
effort to improve access to Part D vaccines routinely recommended by the CDC for all adults, or
based on age or certain health conditions, we continue to encourage Part D sponsors to either
offer a $0 vaccine tier, or to place these vaccines on a formulary tier with low cost-sharing."
However, despite clear direction from CMS, few plans have taken advantage of the
availability of a $0 vaccine tier as a means to improve beneficiary vaccination rates. A 2017
report by Avalere Health found between 47 and 72 percent of the 24 million Medicare
beneficiaries with Part D coverage had some level of cost sharing for vaccines, ranging from $35
to $70 in 2015. Another study found that only 4 percent or less of Medicare Part D enrollees had
access to vaccines with no cost sharing. Medicare beneficiaries deserve better access to high
value preventive immunizations than what is presently available under the Part D benefit.
We encourage CMS to work with Part D sponsors to offer either a $0 vaccine tier, or to
place vaccines on a formulary tier with low cost-sharing. Now is the time to empower vulnerable
elderly and disabled Medicare beneficiaries with the tools they need to stay healthy and out of the
health care system. Immunizations are one of the most reliable and efficient forms of prevention
that we know save lives and billions in avoidable health care costs.
Sincerely,

_______________________ ______________________ _______________________
Mazie K. Hirono Shelley Moore Capito Sheldon Whitehouse
United States Senator United States Senator United States Senator
_______________________ _______________________
Tim Scott Sherrod Brown
United States Senator United States Senator
_______________________ _______________________
David A. Perdue Tina Smith
United States Senator United States Senator
_______________________ /s/ Chris Van Hollen______
Thom Tillis Chris Van Hollen
United States Senator United States Senator
_______________________ /s/ Robert P. Casey, Jr.____
Steve Daines Robert P. Casey, Jr.
United States Senator United States Senator
_______________________
Pat Roberts
United States Senator