IZ Express #1,672: Medicare Part D eliminates out-of-pocket costs for ACIP-recommended vaccines, and more

The Inflation Reduction Act (IRA) eliminated out-of-pocket costs as of January 1, 2023, for Medicare Part D beneficiaries who receive vaccines recommended for adults by the Advisory Committee on Immunization Practices (ACIP). For the first time, people with Medicare’s prescription drug coverage will pay no deductible and will not be responsible for any cost-sharing for ACIP-recommended vaccines, including shingles vaccine, Tdap, and travel vaccines.

Similar benefits take effect on October 1, 2023, for adults insured by Medicaid (those eligible for both traditional and expansion Medicaid coverage) and a small number of young adults covered by the Children’s Health Insurance Program. Between now and October 1, state Medicaid programs not already in compliance will revise their Medicaid vaccine policies to implement the new law.

CMS guidance notes that a Part D enrollee may still be required to pay some or all of the costs of a vaccine given to them if it is not recommended by ACIP for use in adults or is administered to a child younger than age 19 years. If ACIP recommends a new vaccine for adults during the plan year, Part D plan sponsors must require no cost-sharing for any applicable vaccine claims with dates of service after the recommendation is issued. Out-of-network claims also are required to be $0 for an ACIP-recommended adult vaccine.

CMS guidance states that CMS interprets “adult vaccine” and “vaccine . . . for use by adult populations” to refer to vaccines licensed by the FDA and recommended by ACIP for use in adults (age 19 years or older), whether on the CDC/ACIP Adult Immunization Schedule or ACIP recommendations published in MMWR. CMS also interprets the term “recommended” to mean all categories of ACIP recommendations: routinely recommended, recommended only based on shared clinical decision-making, recommended for use only for people with specific risks (such as those with certain medical conditions), and recommended for circumstances that are not mentioned on the Adult Immunization Schedule for routine immunization (e.g., travel).

Medicare Part D plans cover all vaccines that are commercially available, reasonable and necessary to prevent illness, and not covered by Medicare Part B. Medicare Part B vaccines (including influenza and pneumococcal vaccines) have been given to adult beneficiaries without cost-sharing for many years.

This important new Medicare Part D benefit removes financial barriers to vaccination for millions of people age 65 years and older: share the news with your patients, colleagues, and friends. Encourage those with Medicare Part D to get the vaccines they need today.

Related Links

CMS: Inflation Reduction Act CMS Implementation Timeline
CMS Medicare Learning Network: Medicare Part D Vaccines (Jan 2022)
CMS: Reduced Drug Prices, Enhanced Medicare Benefits under Inflation Reduction Act: Frequently Asked Questions (FAQs) (10/5/22)
CMS: The Inflation Reduction Act Lowers Health Care Costs for Millions of Americans (10/5/22)
Avalere Health: Adult Vaccine Coverage in Medicaid: Assessing Existing Gaps and Looking Ahead to Implementation of the Inflation Reduction Act (Dec 2022)

Immunize.org updates its “Ask the Experts: COVID-19” content and other COVID-19-related resources

Immunize.org published a comprehensive update of the clinical answers in its popular Ask the Experts: COVID-19 web page on December 23. This extensive set of clinical questions and answers addresses CDC COVID-19 recommendations and clinical considerations and connects readers with CDC resources. Updates incorporate policy changes made since September 8, such as booster dose recommendations for children who begin the series as early as age 6 months and the limited use of Novavax COVID-19 Vaccine as a first booster dose for some adults.

Immunize.org also revised its four-page job aid, Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools on January 5. The updated checklist provides new dates for the "Ask the Experts COVID-19" web page and CDC’s MMWR index on COVID-19 vaccine effectiveness and safety. Immunize.org updates this checklist at least monthly, prominently indicating when it was last updated at the top of the page. Now is a good time to verify that you are using the most current resources in your practice.

In addition to updating its "Ask the Experts: COVID-19" content, Immunize.org has also retired educational content related to CDC’s special recommendations for infection control during vaccination that were first made in 2020 in response to the COVID-19 pandemic. Those recommendations are no longer in effect; CDC has resumed its routine recommendations for infection control and vaccine administration. Use of masks to prevent transmission of respiratory viruses in vaccination clinics should be based upon professional judgment in the specific circumstances or institutional policy. In response, Immunize.org updated its “Ask the Experts: Administering Vaccines” web page and retired the educational resource “Protective Measures for Vaccinating During the Pandemic,” as well as the web page entitled “COVID-19 and Routine Vaccination.”

Related Links

Immunize.org: Ask the Experts: COVID-19 web page
Immunize.org: Ask the Experts: Administering Vaccines web page
Immunize.org: Ask the Experts main page to access more than 1,200 questions and answers
Immunize.org: Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools (PDF)
Immunize.org: Vaccines: COVID-19 main page
CDC: Interim Clinical Considerations main page summarizing use of COVID-19 vaccines in the United States

Newly updated “65+ Flu Defense” website offers resources for healthcare professionals serving older adults

Confident recommendations for influenza vaccine from healthcare providers are powerfully persuasive. To assist you in maximizing protection for your patients, Immunize.org, in collaboration with CSL Seqirus, updated the 65+ Flu Defense website.

Older adults are at increased risk of severe influenza and COVID-19 illness, including hospitalization and death, especially if they are not up to date on these vaccinations. An updated fact sheet on the website, The Importance of Preventing Influenza and COVID-19, offers responses to help guide discussions with patients on the importance of preventing influenza and COVID-19.

This helpful site includes information, tools, and tips for communicating with adults age 65 and older about the scope and severity of influenza. Resources include:

Check out the updated 65+ Flu Defense website at www.influenza-defense.org to assist your ongoing efforts in protecting this vulnerable population.

Influenza activity on downward slope but remains high; keep encouraging vaccination

Now is the best time to vaccinate anyone not yet protected from influenza this season. CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable snapshot of influenza activity state-by-state.

Influenza Surveillance
For week 52, ending December 31, CDC's Weekly U.S. Influenza Surveillance Report, FluView, reports that nationwide, 5.4% of outpatient visits were due to respiratory illness that included fever plus a cough or sore throat (i.e., influenza-like illness [ILI]). This exceeds the national baseline of 2.5%. Multiple respiratory viruses are co-circulating; the relative contribution of influenza virus infection to ILI varies by location. So far this season, 74 children have died from influenza-associated causes.

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard shows that vaccination coverage for all children age 6 months to age 17 years is similar to coverage in December 2021, but 4.2 percentage points lower than in December 2020. Current pediatric vaccination rates among states and DC varies widely, from 24.6% to 70.4%; national coverage is 47.5%. Most children are still enduring this influenza season without the benefit of vaccination.

CDC recommends everyone age 6 months and older get annual influenza vaccination. “Vaccines.gov” offers VaccineFinder, a service of Boston Children’s Hospital, to help people find influenza and COVID-19 vaccines for any age group. To be listed as a provider by VaccineFinder, see the information at this website.

Related Links

CDC: Weekly National Flu Vaccination Dashboard main page
CDC: FluView main page
CDC: Influenza (Flu) main page
Immunize.org: free educational materials and patient handouts related to influenza
Immunize.org: Vaccines: Influenza main page
Immunize.org: Ask the Experts: Influenza main page
Families Fighting Flu: Flu Resources for Healthcare Professionals main page

January is Cervical Health Awareness Month; promote the importance of HPV vaccination

January is Cervical Health Awareness Month, a great time to share the importance of human papillomavirus (HPV) vaccine. Almost all cervical cancer cases (99%) are linked to infection with high-risk HPV strains, an extremely common virus transmitted through intimate contact.

CDC recommends routine HPV vaccination for all children at age 11 or 12 years and the series may be started at age 9 if preferred. Vaccination is also recommended for all people age 13 through 26 years who have not been vaccinated previously or who have not completed the vaccination series. Children with normal immune systems who receive their first dose before turning age 15 require only two doses; anyone vaccinated at age 15 and older requires three. Adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their clinician.

Protect your patients from cervical cancer, and many other HPV-related cancers, by recommending, promoting, and offering the HPV vaccine.

Related Links

WHO: Cervical Cancer Awareness Month 2023 main page
CDC: Cervical Cancer Awareness web page
CDC: HPV for Healthcare Professionals main page
NCCC: Cervical Health Awareness Month web page
ASHA: Ten Questions to Ask Your Healthcare Provider about Sexual Health web page
Immunize.org: Human Papillomavirus (HPV) main page
Immunize.org: Ask the Experts: Human Papillomavirus (HPV) web page

In this week's Spotlight, we summarize Immunize.org companion websites.

The website of the National Network of Immunization Coalitions, a project of Immunize.org, posts information on more than 100 immunization coalitions and their topics of shared interest.

The National Adult and Influenza Immunization Summit (NAIIS) website addresses adult and influenza immunization issues to improve coverage. NAIIS has more than 900 members, representing more than 130 public and private organizations. It is led by members of the Summit Organizing Committee, including Immunize.org, CDC, HHS, and other organizations.

Vaccine Information You Need, at www.vaccineinformation.org, was launched by Immunize.org in partnership with CDC. This website provides the public with hundreds of valuable resources, including personal testimonies of suffering due to vaccine-preventable diseases, vaccine-related videos and public-service announcements, and educational materials from trusted organizations.

MenACWY: You’re Not Done If You Give Just One, at www.give2menacwy.org, supports a national campaign produced by Immunize.org and Sanofi Pasteur to improve protection from disease caused by meningococcal serogroups A, C, W, and Y. It offers information for families and resources for providers to boost on-time delivery of both doses of the MenACWY vaccine.

65+ Flu Defense, at www.influenza-defense.org, produced by Immunize.org and CSL Seqirus, is a website with tools to help protect patients 65 and older, all of whom are at greater risk of influenza complications.

Related Link

Journalists seek out Immunize.org experts to help explain vaccines to the public and policy makers. We help the media understand and communicate the complex work vaccinators do. Here is a selection of our recent citations.

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.

IZ Express regularly provides readers with information about Immunize.org’s new and updated educational materials for healthcare professionals and handouts for patients. All Immunize.org materials are free to distribute.

In case you missed them during recent weeks, updates were made to these helpful materials.

Immunize.org Materials for Clinicians

Thanks to CDC support Immunize.org substantially expanded its repository of Vaccination Information Statement (VIS) translations. In November and December, Immunize.org posted new and updated VIS translations for DTaP, Hib, hepatitis A, hepatitis B, and smallpox/mpox vaccines.

All translations are available in print-ready PDF format.

DTaP (Diphtheria, Tetanus, Pertussis) VIS (view in English):

Check the version dates of your office copies of newly updated translations. Translations of previous VIS versions should be discarded now that translations of the current versions are available.

IZ Express regularly provides readers with information about Vaccine Information Statements (VISs) and translations of VISs. In November, with support from CDC, Immunize.org began working with partners to significantly increase the number of VIS translations available. If your facility works with patients whose primary language is not English, please review and use these translations when needed.

In November, CDC released an update to the Smallpox/Monkeypox VIS and Immunize.org posted 28 translations. Fifty additional translations of other VISs were also added:

On December 13, Immunize.org and experts from the Autism Society hosted a 1-hour webinar, Improving the Vaccination Experience: Accessible Vaccination for Neurodiverse People at Any Age. In this webinar, participants learned more about the Autism Society’s practical tips to improve vaccine confidence by employing strategies to reduce stress when vaccinating neurodiverse patients.

People with autism and other developmental disabilities have lower childhood vaccination rates than their peers without autism, leaving them vulnerable to many vaccine-preventable diseases. The vaccination visit can be especially stressful for these families. Effective strategies exist to reduce pain and anxiety during the vaccination visit.

The video of the webinar is available at our website for on-demand viewing. Please share this important webinar with your colleagues.

Immunize.org launched a new social media program to highlight our educational resources for a new audience of vaccinators. Our social media channels now feature our most popular printable resources and Ask the Experts questions, as well as announcements important to frontline vaccinators. Our Instagram account is new and we need your support to build our following!

Like, follow, and share Immunize.org’s social media accounts and encourage colleagues and others interested in vaccination to do likewise:

Each additional follower extends the reach of our work to help healthcare professionals deliver quality vaccination services to people of all ages.

CDC published Racial and Ethnic Differences in COVID-19 Vaccination Coverage among Children and Adolescents Aged 5–17 Years and Parental Intent to Vaccinate Their Children—National Immunization Survey–Child COVID Module, United States, December 2020–September 2022 on January 6 in MMWR. A portion of the summary appears below.

Some racial and ethnic groups are at increased risk for COVID-19–associated morbidity and mortality because of systemic and structural inequities. Vaccination is effective in preventing severe COVID-19–related outcomes. . . .

Among children and adolescents aged 5–17 years, ≥1-dose COVID-19 vaccination coverage was low overall, but highest among Asian and Hispanic or Latino children and adolescents. Parental intent to vaccinate their child varied by the child’s age, race, and ethnicity. Parents of unvaccinated children and adolescents reported low confidence in vaccine safety, and a low percentage reported receipt of a provider vaccination recommendation. . . .

To increase overall coverage and address disparities in child and adolescent COVID-19 vaccination coverage, providers and trusted messengers should provide culturally relevant information and vaccine recommendations.

Access the MMWR article in HTML or PDF.

Related Link

MMWR's main page provides access to MMWR Weekly and its companion publications

“Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19–Associated Emergency Department or Urgent Care Encounters and Hospitalizations among Immunocompetent Adults—VISION Network, Nine States, September–November 2022” published in MMWR

CDC published Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19–Associated Emergency Department or Urgent Care Encounters and Hospitalizations among Immunocompetent Adults—VISION Network, Nine States, September–November 2022 on December 30 in MMWR. A portion of the summary appears below.

Bivalent mRNA COVID-19 booster doses containing an Omicron BA.4/BA.5 sublineage component were recommended on September 1, 2022. . . .

Bivalent booster doses provided additional protection against COVID-19–associated emergency department/urgent care encounters and hospitalizations in persons who previously received 2, 3, or 4 monovalent vaccine doses. Because of waning of monovalent vaccine-conferred immunity, relative effectiveness of bivalent vaccines was higher with increased time since the previous monovalent dose. . . .

All persons should stay up to date with recommended COVID-19 vaccinations, including receiving a bivalent booster dose if eligible.

Access the MMWR article in HTML or PDF.

Related Link

MMWR's main page provides access to MMWR Weekly and its companion publications

“Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19–Associated Hospitalization among Immunocompetent Adults Aged ≥65 Years—IVY Network, 18 States, September 8–November 30, 2022” published in MMWR

CDC published Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19–Associated Hospitalization among Immunocompetent Adults Aged ≥65 Years—IVY Network, 18 States, September 8–November 30, 2022 on December 30 in MMWR. A portion of the summary appears below.

Immunity from monovalent COVID-19 mRNA vaccination wanes over time. A bivalent COVID-19 mRNA booster dose is recommended for all eligible persons; . . .

Among immunocompetent adults aged ≥65 years hospitalized in the multistate IVY Network, a bivalent booster dose provided 73% additional protection against COVID-19 hospitalization compared with past monovalent mRNA vaccination only. . . .

To maximize protection against severe COVID-19 this winter season, all eligible persons, especially adults aged ≥65 years, should receive a bivalent booster dose and consider additional prevention strategies, including masking in indoor public spaces.

Access the MMWR article in HTML or PDF.

Related Link

MMWR's main page provides access to MMWR Weekly and its companion publications

Analysis of mpox infections among unvaccinated persons and those who had received 1 JYNNEOS vaccine dose ≥14 days before illness onset found that the odds of fever, headache, malaise, myalgia, and chills were significantly lower among vaccinated patients than among unvaccinated patients. Overall, 2% of vaccinated persons with mpox and 8% of unvaccinated patients were hospitalized. . . .

One dose of JYNNEOS vaccine might attenuate the severity of illness and reduce hospitalization in persons who become infected after vaccination; however, to optimize protection, all eligible persons are recommended to complete the 2-dose vaccination series.

Access the MMWR article in HTML or PDF.

Related Links