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
Medicare	Federal health insurance program for: People who are 65 or older Certain younger people with disabilities People with End-Stage Renal Disease (ESRD)	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
Medicaid	Federal and state health insurance program with adult coverage for: Pre-expansion adult populations (i.e., pregnant women and very low-income adults) Expansion population low-income adults	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.

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.