Texans know Abilene is a great place to retire.
The city is large enough to provide the amenities retirees want, but small enough to still feel cozy. The cost of living is low—a real plus in these high-inflation times—and there’s access to a wide range of medical professionals. But seniors on Medicare may be surprised to learn they have to spend money for vaccines regardless of where they live.
Under current law, people with traditional health insurance don’t pay out of pocket for vaccines, but many seniors on Medicare do. And that out-of-pocket cost can be substantial.
Currently, federal law requires standard health insurance policies to cover preventive care with no patient out-of-pocket cost. Vaccines are considered preventive care, but that rule doesn’t apply to seniors on Medicare.
Medicare Part B provides coverage for the flu, pneumonia, and COVID-19 vaccines with no patient out-of-pocket cost. However, most seniors’ prescription drugs are covered by a Medicare Part D prescription drug plan or by joining a Medicare Advantage (MA) plan. While Part D covers vaccines, as do many MA plans, patients may face a copay — in some cases a significant copay.
A recent study for the Galen Institute notes that Medicare Part D is an “outlier” when it comes to requiring beneficiaries to share the cost of vaccines. And unfortunately, that cost sharing reduces vaccine uptake. One example is the current shingles vaccine. The study noted a 40-60% higher uptake in Part D enrollees when no cost sharing was required.
That discrepancy needs to change because vaccines will increasingly become the way we prevent, and even treat, many of the most deadly and intractable diseases.
The new mRNA technology used to develop COVID-19 vaccines allows scientists to vastly accelerate the development process, while expanding the diseases and medical conditions that might be prevented or treated by vaccines.
The first mRNA-based shingles vaccine is currently being developed by one pharmaceutical company. Another has plans for human trials on 15 threatening viruses — an effort to be prepared for future pandemics.
And that’s only the beginning. Pharmaceutical manufacturers look to apply mRNA technology to other diseases such as Ebola, mosquito-borne viruses, HIV, malaria and tuberculosis.
While the cost of the COVID-19 vaccines was very reasonable, that was in part based on the government ordering hundreds of millions of doses. The next generation of mRNA vaccines will likely be more expensive.
What can we do to ensure that all seniors can access these new vaccines? Here are two action items.
First, make sure that new vaccine development isn’t bogged down by unnecessary, counterproductive, and costly bureaucratic and regulatory processes — roadblocks that have plagued pharmaceutical development for decades.
It can take 10 to 12 years for a new drug to jump through all of the bureaucratic hoops for full U.S. Food and Drug Administration approval. That process costs time, money — and lives.
COVID-19 vaccines enjoyed an expedited approval process without compromising patient safety, providing a model for future vaccines.
Second, we need to ensure that cost isn’t a barrier. Seniors tend to be the most vulnerable segment of the population. They will likely benefit most from new, and even existing, vaccines. And they tend to be on limited or fixed incomes, with little discretionary income to make large copays.
This is a public policy problem that needs fixing. There is proposed legislation in Congress that would require Part D insurers to cover vaccines with no out-of-pocket costs. Alternatively, all vaccines could be placed under Medicare part B.
Whatever the approach, it is time to ensure that seniors have the same no-cost access to vaccines as the rest of the population, ensuring they can live out those retirement years without unexpected costs.