Protecting Seniors Through Immunization Act of 2016

Summary: Protecting Seniors Through Immunization Act of 2016 This bill amends title XVIII (Medicare) of the Social Security Act to specify that certain deductible, coinsurance, initial coverage limit, and cost-sharing requirements that apply under the Medicare prescription drug benefit shall not apply with respect to the shingles vaccine.  The Centers for Medicare &amp; Medicaid Services must provide to Medicare beneficiaries specified information regarding: (1) coverage of vaccines for seniors, and (2) access to the shingles vaccine without cost-sharing.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Seniors Through 
Immunization Act of 2016''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Herpes zoster, also known as shingles, is caused by the 
        reactivation of the varicella-zoster virus that causes 
        chickenpox in childhood. The virus can reactivate later in 
        life, resulting in a painful, itchy rash that can persist for 
        weeks, months, or years. Not only does the risk of herpes 
        zoster itself increase with age, but, among individuals who 
        experience herpes zoster, older individuals are much more 
        likely to experience postherpetic neuralgia non-pain 
        complications, hospitalizations, and interference with 
        activities of daily living, such as eating, dressing, and 
        bathing.
            (2) Postherpetic neuralgia, a complication of shingles, 
        occurs rarely among individuals under age 40 but can occur in 
        up to \1/3\ of untreated individuals age 60 and older.
            (3) The Food and Drug Administration approved the herpes 
        zoster vaccine for individuals age 50 and older. The Advisory 
        Committee on Immunization Practices presently recommends the 
        herpes zoster vaccine for all individuals age 60 and older.
            (4) The Healthy People 2020 target baseline for the herpes 
        zoster vaccine is 30 percent coverage for individuals age 60 
        and over. This benchmark is unfortunately low compared to that 
        of other adult vaccines such as influenza (70 percent) and 
        pneumococcal disease (60 percent). Even at such a low target, 
        the coverage rate is not being met. The Centers for Disease 
        Control and Prevention reported that in 2014, only 28 percent 
        of adults age 60 and older reported receiving the herpes zoster 
        vaccine.
            (5) According to the 2014 National Health Interview Survey 
        of the Centers for Disease Control and Prevention, vaccination 
        rates for adults are 20 percent for Tetanus, Diphtheria, and 
        Pertussis, 28 percent for shingles, 24 percent for Hepatitis B, 
        and 61 percent for pneumonia. There are also disparities across 
        adult vaccination rates. Adult immunization rates are generally 
        lower among Hispanics, African-Americans, and Asians.
            (6) Medicare coverage for the herpes zoster vaccine under 
        the Prescription Drug Program under part D of title XVIII of 
        the Social Security Act has resulted in many barriers to 
        optimal and consistent uptake to prevent shingles and its 
        costly and painful complications.
            (7) Lack of awareness and logistical and financial 
        challenges are the most often cited reasons for Medicare 
        beneficiaries not being immunized against the varicella-zoster 
        virus.
            (8) Herpes zoster is estimated to account for more than 
        87,000 emergency room visits and 28,000 inpatient admissions 
        each year. Average costs across the episode of care were $1,835 
        and $14,428 per patient in the outpatient and inpatient 
        settings, respectively.

SEC. 3. PROVISION OF INFORMATION REGARDING VACCINES FOR SENIORS AS PART 
              OF MEDICARE & YOU HANDBOOK AND COVERAGE OF THE SHINGLES 
              VACCINE UNDER MEDICARE PART D.

    (a) Provision of Information Regarding Vaccines for Seniors as Part 
of Medicare & You Handbook.--
            (1) In general.--Section 1804 of the Social Security Act 
        (42 U.S.C. 1395b-2) is amended--
                    (A) in subsection (a)(1), by inserting ``, 
                including information with respect to coverage of 
                vaccines for seniors described in subsection (d)'' 
                before the comma at the end; and
                    (B) by adding at the end the following new 
                subsection:
    ``(d) The notice provided under subsection (a) shall include 
information with respect to vaccines for seniors, including information 
with respect to coverage of the shingles vaccine under part D for 
individuals enrolled in a prescription drug plan under such part.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to notices distributed prior to each Medicare open 
        enrollment period beginning after the date of implementation of 
        section 1860D-2(b)(8), as added by subsection (b)(2).
    (b) Coverage of the Shingles Vaccine Under Medicare Part D.--
            (1) Provision of educational materials regarding the 
        availability of acip-recommended herpes vaccine with no cost 
        sharing.--Section 1860D-4(a)(1)(B) of the Social Security Act 
        (42 U.S.C. 1395w-104(a)(1)(B)) is amended by adding at the end 
        the following new clause:
                            ``(v) For plan years beginning on or after 
                        January 1 of the first year beginning more than 
                        60 days after the date of the enactment of this 
                        clause, information regarding access to the 
                        shingles vaccines with no cost sharing under 
                        the plan.''.
            (2) Ensuring treatment of cost sharing is consistent with 
        treatment of vaccines under medicare part b.--Section 1860D-
        2(b) of the Social Security Act (42 U.S.C. 1395w-102(b)) is 
        amended--
                    (A) in paragraph (1)(A), by striking ``the 
                coverage'' and inserting ``Subject to paragraph (8), 
                the coverage'';
                    (B) in paragraph (2)(A), by striking ``and (D)'' 
                and inserting ``and (D) and paragraph (8)'';
                    (C) in paragraph (3)(A), by striking ``and (4)'' 
                and inserting ``(4), and (8)'';
                    (D) in paragraph (4)(A)(i), by striking ``The 
                coverage'' and inserting ``Subject to paragraph (8), 
                the coverage''; and
                    (E) by adding at the end the following new 
                paragraph:
            ``(8) Treatment of cost sharing for shingles vaccine 
        consistent with treatment of vaccines under part b.--For plan 
        years beginning on or after January 1 of the first year 
        beginning more than 60 days after the date of the enactment of 
        this paragraph:
                    ``(A) No application of deductible.--The deductible 
                under paragraph (1) shall not apply with respect to the 
                shingles vaccine.
                    ``(B) No application of coinsurance.--There shall 
                be no coinsurance under paragraph (2) with respect to 
                the shingles vaccine.
                    ``(C) No application of initial coverage limit.--
                The initial coverage limit under paragraph (3) shall 
                not apply with respect to the shingles vaccine.
                    ``(D) No cost sharing above annual out-of-pocket 
                threshold.--There shall be no cost sharing under 
                paragraph (4) with respect to the shingles vaccine.''.
            (3) Conforming amendments to cost sharing for low-income 
        individuals.--Section 1860D-14(a) of the Social Security Act 
        (42 U.S.C. 1395w-114(a)) is amended--
                    (A) in paragraph (1)(D), in each of clauses (ii) 
                and (iii), by striking ``In the case'' and inserting 
                ``Subject to paragraph (6), in the case'';
                    (B) in paragraph (2)--
                            (i) in subparagraph (D), by striking ``The 
                        substitution'' and inserting ``Subject to 
                        paragraph (6), the substitution''; and
                            (ii) in subparagraph (E), by striking 
                        ``subsection (c)'' and inserting ``paragraph 
                        (6) and subsection (c)''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(6) No application of cost sharing for shingles 
        vaccine.--Consistent with section 1860D-2(b)(8), for plan years 
        beginning on or after January 1 of the first year beginning 
        more than 60 days after the date of the enactment of this 
        paragraph, there shall be no cost sharing under this section 
        with respect to the shingles vaccine.''.
    (c) Study and Report.--
            (1) Study.--The Secretary of Health and Human Services 
        (referred to in this subsection as the ``Secretary''), acting 
        through the Director of the Centers for Disease Control and 
        Prevention, in collaboration with the Administrator of the 
        Centers for Medicare & Medicaid Services, shall conduct a study 
        on the uptake of vaccines, including the herpes zoster vaccine 
        and the tetanus, diphtheria, and pertussis vaccine, and 
        anticipated vaccines against such diseases as respiratory 
        syncytial virus, clostridium difficile, and others. Such study 
        shall include an analysis of ways to--
                    (A) increase the baseline target rate of coverage 
                for currently recommended vaccines, such as herpes 
                zoster vaccine coverage in the Healthy People 2030 
                goals;
                    (B) ensure that the baseline target focuses on 
                reducing racial and socio-economic disparities in the 
                vaccine coverage rates for all adult vaccines, 
                including the herpes zoster vaccine; and
                    (C) help facilitate vaccination for Medicare 
                beneficiaries for vaccines recommended by the Centers 
                for Disease Control and Prevention both currently and 
                in the future, by developing and evaluating a specific 
                set of actions that will address physician and health 
                care provider administrative challenges, such as 
                difficulty verifying beneficiary coverage and 
                complexity of physician office billing of vaccines 
                covered under Medicare part D, that impact access for 
                beneficiaries.
            (2) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall submit to Congress a 
        report containing the results of the study under paragraph (1), 
        together with recommendations for such legislation and 
        administrative action as the Secretary determines appropriate.