Vaccines for Seniors in Jeopardy
When talking about policy improvements for older adults and vaccines, it can seem like a one step forward two steps back scenario.
On one hand, older adults are often the most willing to roll up their sleeves and believe in the value of vaccines. That’s likely due to having lived in a time where diseases like measles, chicken pox and polio made people very sick or worse. But on the other hand, research continually shows that seventy five percent of adults aged 65 and older are missing at least one recommended vaccine.
Another example—under the Inflation Reduction Act, all vaccines that have been recommended by the CDC no longer have any cost sharing requirements for Medicare Part D participants. But now, there’s reason to believe that access to vaccines for adults enrolled in Medicare Part D could be in jeopardy.
Why? Insurance companies may be looking at limiting what vaccines they offer to the more than 50 million Americans covered under the Medicare Part D program.
At the end of 2023, the Centers for Medicare and Medicaid Services (CMS) sent a letter to insurers and pharmacy benefit managers outlining concerns about “certain practices by some plans and PBMs that threaten the sustainability of many pharmacies, impede access to care, and put increased burden on health care providers.”
The concern is that insurers and PBMs could limit the number of vaccines on their formularies which could potentially limit an individual’s personal health choices, exacerbate vaccine shortages and further erode the doctor-patient relationship by dictating healthcare choices.
CMS also raised concerns that insurers were limiting reimbursement rates to some pharmacies for vaccine administration. This could have a devastating impact. It was true before the pandemic, but even more so since, pharmacists play a huge roll in American’s healthcare. Squeezing pharmacies out of the vaccination market would exacerbate the already existing issue of vaccine compliance. At a time when we have more vaccines than ever to combat diseases that impact older adults—think RSV and COVID—how could anyone justify practices that would limit availability?
We can’t let this stand. CMS did the right thing in flagging these concerns early, and they must push back on any attempts to limit vaccine access. For the health of all Americans, but especially those we serve, we need our regulatory bodies to do what’s right to preserve strong immunization supplies and access.
Saul Anuzis is president of 60 Plus, the American Association of Senior Citizens.
