Medicare Part D Cost Sharing Trends for Adult Vaccines

Vaccination utilization among U.S. adults is low, and well below the Healthy People 2020 targets, despite widespread availability of safe and effective vaccines and long-standing use recommendations by the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices. The 2010 Affordable Care Act eliminated some coverage and financial access barriers to adult vaccinations covered by private health insurance and Medicaid, but it did not substantially change vaccine utilization or cost sharing for beneficiaries enrolled in Medicare Part D. The law requires that Medicare Part D plans cover all commercially available vaccines not already covered under Medicare Part B, if the vaccine is reasonable and necessary to prevent illness.

In a new issue brief, Manatt’s analysis showed that despite encouragement by the Centers for Medicare & Medicaid Services for Part D plans to provide vaccines without cost sharing to incentivize the use of these preventive services, about 4% or less of Medicare Part D enrollees had access to the vaccines examined in this study with no cost sharing, depending on the vaccine, in either Medicare Advantage Part D Prescription Drug Plans or stand-alone Prescription Drug Plans (PDPs) for CY 2017, with little change since 2015. Importantly, no PDPs offered zero-dollar cost sharing for the vaccines under study between 2015 and 2017.

GlaxoSmithKline provided funding for this analysis. Manatt Health Strategies, LLC, maintained full editorial control over the selection of the vaccines, methodology and content of this issue brief and the accompanying chart pack.

Click here to read the full issue brief.

Click here to read the accompanying chart pack.