Adult Vaccines - Outlook for 2023February 9, 2023
As we continue to move into 2023, there are several exciting new developments that have implications for adult vaccine availability, coverage, and access. These include not only the new policy changes included in the Inflation Reduction Act of 2022 (IRA) that expand and improve adult vaccine coverage for Medicare and Medicaid beneficiaries, but also the promise of new advancements in vaccine innovation for diseases such as respiratory syncytial virus (RSV).
The COVID-19 pandemic had a significant impact on decreasing routine immunization rates both for children and adults — but it also provided lessons learned on how to address equity issues and system barriers that can be leveraged moving forward to improve rates. This is especially important to protect against respiratory diseases as we saw this year with the “tripledemic.”
Although recommended vaccines, excluding flu for adults, on average remain below pre-pandemic levels, building on these new developments in 2023 can drive improvements. There is also a tremendous opportunity now to re-envision a more systematic approach to adult vaccination by maximizing uptake to create healthier communities and a more resilient public health infrastructure.
IRA Improves Access to Vaccines for Adults
The IRA addressed significant remaining coverage and access gaps for adult vaccines for Medicare and Medicaid. Until now, financial barriers remained one of the most impactful and avoidable roadblocks to prevention. One study from IQVIA previously found that immunization uptake would increase by nearly 60% overall if cost sharing was eliminated1. Even more striking, the same study showed Black and Hispanic uptake would increase by 91% and 89% respectively, again underscoring ability to address disparities to ensure equitable access and utilization1. Once implemented, nearly 9 out of 10 Americans will have access to recommended vaccines with no cost sharing2.
Specifically, the provisions eliminated cost sharing for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) under Medicare Part D like the shingles vaccine and expanded coverage without cost sharing for all ACIP recommended vaccines to additional populations of adult Medicaid beneficiaries. The Centers for Medicare and Medicaid Services (CMS) is working to implement these provisions.
|Program||Adult Population||Vaccine Coverage before IRA||After IRA|
Federal health insurance program for:
Some vaccines in Medicare are covered under Medicare Part B like flu, pneumonia and COVID-19. There is no cost-sharing for Part B vaccines.
All other recommended vaccines (like shingles vaccine) in Medicare are covered under the Medicare Part D program. There was cost sharing for Part D vaccines.
Eliminated cost-sharing for Part D vaccines
Implementation: January 1, 2023
Federal and state health insurance program with adult coverage for:
Adults in the Medicaid expansion population have coverage for recommended vaccines with no cost-sharing.
Other adult populations covered under Medicaid had coverage for recommended vaccines at discretion of the state and cost-sharing was determined by state as well.
All Medicaid adults have coverage for ACIP recommended vaccines without cost-sharing.
Implementation: October 2023
- CMS already implementing Part D coverage changes. CMS has already started to implement changes for Part D program coverage so that beneficiaries will not face any cost-sharing for recommended vaccines moving forward. This change started at the beginning of 2023.
- CMS will implement Medicaid provisions in October. CMS will work with states to roll out the new Medicaid provisions for October.
New Vaccines Coming to Market
There are also new vaccines expected to become available in the second half of 2023 for RSV for adults. RSV is a disease that has significant health implications for older adults as well as for children. In fact, there was a surge in RSV cases at the end of 2022 leading to renewed concerns with this infectious disease. It is especially important that there are a number of advanced RSV vaccine candidates currently in the pipeline. Later this month, regulators from the FDA and CDC will continue reviewing several RSV vaccines, which are anticipated to be licensed and recommended in late spring.
WHAT IS ACIP AND WHAT DOES IT DO?
The Advisory Committee on Immunization Practices (ACIP) is a federal advisory group composed of medical and public health experts who develop and vote on recommendations on the use of vaccines in the United States. ACIP recommendations, once endorsed by the CDC Director, stand as official public health guidance for the use of vaccines and related agents for effective control of vaccine-preventable diseases in the civilian population of the United States3.
Next Stage of Vaccines for COVID-19
As the U.S. lays out the strategy to move beyond the pandemic phase of COVID-19, there will be transitions out of the public health emergency to a more endemic approach to the COVID-19 response. This will lead to changes in how the vaccine has been purchased by the U.S. government, moving away from being the primary purchaser of the vaccines to the commercialization of COVD-19 vaccines. Furthermore, the Food and Drug Administration (FDA) is considering the cadence of regular vaccinations for COVID-19 and moving to an annual bi-valent vaccine, similar to flu4 .
Addressing Health Disparities and Vulnerable Populations
The pandemic highlighted the need to better address disparities in access to vaccinations in the U.S. both for underserved communities as well as for especially vulnerable populations (like those in nursing homes). At the federal and state level there have been newly developed task forces charged with improving health equity and advancing improvements in care. There has also been strong engagement with underserved community groups and providers serving those communities (such as federally qualified health centers (FQHCs) and retail pharmacies) to strengthen the availability and delivery of vaccines in those areas or settings. With this strong emphasis, we expect to see opportunities to improve access and utilization among underserved or vulnerable populations in 2023.
What to Watch for in 2023
- Improvements in Vaccine Utilization for Medicare and Medicaid Populations. The IRA’s changes remove significant obstacles for Medicare beneficiaries and adult Medicaid beneficiaries by eliminating cost sharing and expanding coverage for ACIP recommended vaccines in traditional Medicaid plans. Policymakers should be closely following how these changes may positively impact utilization but also further identify any barriers to coverage. Vaccine Track will also look for changes in uptake trends, sign up here to receive quarterly updates.
- Harnessing COVID-19 Learnings to Address Disparities in Vaccine Access and Uptake. There is significant federal and state focus on improving access and use of recommended vaccines in underserved communities and we expect continued efforts to ensure all populations are able to receive important vaccines. As interest in this area continues, we also expect a focus on improving data to better understand the disparities and to track progress.
- Re-thinking the approach to clarify and simplify the timing of receiving vaccines over the year to maximize opportunities. Realizing the full potential of adult vaccination requires a system-wide approach and integrating several tools — building on community partnerships, education, the immunizer workforce and assuring access for all stakeholders. The number of recommended vaccinations for adults is increasing, including those that may be required annually. Ensuring that stakeholders understand the timing and schedule of vaccinations needed for protection and remain engaged in receiving them is very important. Stakeholders can consider opportunities to organize the annual immunization schedules and assist patients in receiving all recommended shots throughout the year.
- Ensuring Timely Coverage and Access to New Vaccines. With a vote by ACIP on potential vaccines for RSV for adults anticipated in June, it will be important to facilitate access to recommended vaccines for eligible adults as soon as possible ahead of next year’s respiratory disease season.
As Vaccine Track collects information and continues to evolve as a vaccine monitoring tool, insights on these and other issues will be provided throughout the year.
1 Medicare D Cost Sharing Reduces Vaccine Uptake and Perpetuates Health Inequities - IQVIA
2 The Inflation Reduction Act Will Help the U.S. Achieve Maximum Vaccine Access and Uptake, but Access Gaps Remain - Epstein Becker & Green, P.C. (ebglaw.com)
3 Charter of the Advisory Committee on Immunization Practices (ACIP) (cdc.gov)
4 Vaccines and Related Biological Products Advisory Committee January 26, 2023 Meeting Announcement - 01/26/2023 | FDA