The COVID-19 pandemic created significant disruptions in routine preventative care, including for immunizations. While many adult vaccination rates were well below national targets in 2019, Vaccine Track uses 2019 as a pre-pandemic high water mark for adult vaccination numbers and offers subsequent month-on-month comparisons to visualize changing trends in adult vaccination claims in the U.S.

Vaccine claims data are data from claims submitted when immunizations are administered to patients. The vaccine claims data in this tool include data from both medical claims and pharmacy claims for vaccines. The medical claim is a request for payment that an enrollee or health care provider submits to a health insurer when an item or service is provided that should be covered by your plan. A pharmacy claim represents paid items or services rendered.

No. True immunization coverage rates cannot be calculated with claims data due to lack of longitudinal follow up. Future iterations of Vaccine Track could project an estimated immunization coverage rate.

For the initial launch of Vaccine Track, the data focuses on adult vaccine claims. There are several reasons for this. First, adult immunization rates remain suboptimal and off national targets and the COVID-19 pandemic has had significant impact on adult vaccine uptake in the U.S. Vaccine Track aims to elucidate trends in adult vaccine claims data that have historically lagged in terms of up-to-date reporting. Additionally, there are limitations with both the availability and variability of data on vaccines provided through the Vaccines for Children (“VFC”) Program, which may not fully capture the population.

No. Vaccine Track visualizes raw and projected vaccine claims data and reports total administrations. Future iterations of Vaccine Track could assess series completion for multidose vaccinations.

• Cash (or Self-Pay): Direct patient payment for services (possibly due to lack of insurance coverage or opting to not use insurance coverage).

• Medicaid: Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Some states have also elected to expand Medicaid eligibility to low-income adults as defined under the Affordable Care Act (“ACA”) — Medicaid expansion adults. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. Under the ACA’s Medicaid expansion, covered adults are eligible for all CDC-recommended vaccines without cost-sharing. The Inflation Reduction Act of 2022 (IRA) expanded coverage of CDC-recommended vaccines for all adults with Medicaid, effective October 1, 2023. Prior to this, coverage and cost-sharing for recommended vaccines for the non-Medicaid expansion adult population varied as states could elect whether they covered these vaccines and whether there was cost-sharing.
  States also have two approaches to delivering and paying for health care services in Medicaid:

  • Medicaid Fee-for-Service (“FFS”). States may pay for some or all Medicaid benefits directly on behalf of beneficiaries which is known as Medicaid fee-for-service (FFS).

  • Medicaid Managed Care. Some states may choose to contract with managed care organizations to provide the Medicaid benefit to eligible enrollees. In these states, managed care organizations provide the Medicaid benefit to some or all Medicaid beneficiaries. However, some states “carve out” coverage of select benefits from managed care, such as drug coverage, and manage those benefits under FFS, which will largely show up in FFS claims.

• Commercial: Private insurance coverage that includes employer and other group health plans, small group and individual coverage (both on and off Health Insurance Exchanges). Private commercial plans cover all CDC-recommended vaccines without cost-sharing.

• Medicare: Medicare provides health insurance for people age 65 or older, for persons under 65 with certain disabilities, and for individuals any age with end-stage renal disease. Coverage for vaccines in Medicare is split between vaccines covered under Medicare Part B and vaccines covered under Medicare Part D. Medicare beneficiaries may receive coverage through fee-for-service Medicare or through Medicare Advantage plans which are private plans offering the Medicare benefit. In future versions of the tool, these populations may be analyzed separately.

  • Medicare Part B: Medicare Part B covers influenza, pneumococcal, hepatitis B for high-risk populations, and COVID-19 without cost-sharing.

  • Medicare Part D: Medicare Part D provides voluntary drug coverage to those 65+, under 65 with certain disabilities, or any age with end-stage renal disease. Medicare Part D covers all other CDC-recommended vaccines that are not covered by Medicare Part B. The Inflation Reduction Act of 2022 (IRA) eliminated cost-sharing requirements for CDC-recommended Part D vaccines effective January 1, 2023.

While this data presents Medicaid FFS claims, there are limitations to the data captured even for Medicaid FFS population. The Medicaid FFS data does not include immunization data for Medicaid FFS beneficiaries that received immunizations at public health departments, Federally Qualified Health Centers (“FQHCs”) or through some state vaccine purchasing programs.

Previously, Medicaid managed care data was included in the Commercial data as third-party payer data. In a recent enhancement, more granular plan information was leveraged to identify and break out Medicaid managed care claims from the Commercial rollup.