I 

115TH CONGRESS 

1ST SESSION H. R. 4297 

To amend title XVIII of the Social Security Act to provide information 

regarding vaccines for seniors as part of the Medicare & You handbook 

and to ensure that the treatment of cost sharing for vaccines under 

Medicare part D is consistent with the treatment of vaccines under 

Medicare part B, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 8, 2017 

Mr. BUCSHON (for himself and Mr. GENE GREEN of Texas) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

information regarding vaccines for seniors as part of 

the Medicare & You handbook and to ensure that the 

treatment of cost sharing for vaccines under Medicare 

part D is consistent with the treatment of vaccines under 

Medicare part B, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Protecting Seniors 

3 Through Immunization Act of 2017’’. 

4 SEC. 2. FINDINGS. 

5 Congress makes the following findings: 

6 (1) Herpes zoster, also known as shingles, is 

7 caused by the reactivation of the varicella-zoster 

8 virus that causes chickenpox in childhood. The virus 

9 can reactivate later in life, resulting in a painful, 

10 itchy rash that can persist for weeks, months, or 

11 years. Not only does the risk of herpes zoster itself 

12 increase with age, but, among individuals who expe13 rience herpes zoster, older individuals are much 

14 more likely to experience postherpetic neuralgia non15 pain complications, hospitalizations, and interference 

16 with activities of daily living, such as eating, dress17 ing, and bathing. 

18 (2) Postherpetic neuralgia, a complication of 

19 shingles, occurs rarely among individuals under age 

40 but can occur in up to 1 20 ⁄3 of untreated individ21 uals age 60 and older. 

22 (3) The Food and Drug Administration ap23 proved the herpes zoster vaccine for individuals age 

24 50 and older. The Advisory Committee on Immuni25 zation Practices presently recommends the herpes 

26 zoster vaccine for all individuals age 60 and older. 


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1 (4) The Healthy People 2020 target baseline 

2 for the herpes zoster vaccine is 30 percent coverage 

3 for individuals age 60 and over. This benchmark is 

4 unfortunately low compared to that of other adult 

5 vaccines such as influenza (70 percent) and pneumo6 coccal disease (60 percent). Even at such a low tar7 get, the coverage rate is not being met. The Centers 

8 for Disease Control and Prevention reported that in 

9 2014, only 28 percent of adults age 60 and older re10 ported receiving the herpes zoster vaccine. 

11 (5) According to the 2014 National Health 

12 Interview Survey of the Centers for Disease Control 

13 and Prevention, vaccination rates for adults are 20 

14 percent for Tetanus, Diphtheria, and Pertussis, 28 

15 percent for shingles, 24 percent for Hepatitis B, and 

16 61 percent for pneumonia. There are also disparities 

17 across adult vaccination rates. Adult immunization 

18 rates are generally lower among Hispanics, African 

19 Americans, and Asians. 

20 (6) Medicare coverage for the herpes zoster vac21 cine under the Prescription Drug Program under 

22 part D of title XVIII of the Social Security Act has 

23 resulted in many barriers to optimal and consistent 

24 uptake to prevent shingles and its costly and painful 

25 complications. 


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1 (7) Lack of awareness and logistical and finan2 cial challenges are the most often cited reasons for 

3 Medicare beneficiaries not being immunized against 

4 the varicella-zoster virus. 

5 (8) Herpes zoster is estimated to account for 

6 more than 87,000 emergency room visits and 28,000 

7 inpatient admissions each year. Average costs across 

8 the episode of care were $1,835 and $14,428 per pa9 tient in the outpatient and inpatient settings, respec10 tively. 

11 SEC. 3. PROVISION OF INFORMATION REGARDING VAC12 CINES FOR SENIORS AS PART OF MEDICARE 

13 & YOU HANDBOOK AND COVERAGE OF THE 

14 SHINGLES VACCINE UNDER MEDICARE PART 

15 D. 

16 (a) PROVISION OF INFORMATION REGARDING VAC17 CINES FOR SENIORS AS PART OF MEDICARE & YOU

18 HANDBOOK.— 

19 (1) IN GENERAL.—Section 1804 of the Social 

20 Security Act (42 U.S.C. 1395b–2) is amended— 

21 (A) in subsection (a)(1), by inserting ‘‘, in22 cluding information with respect to coverage of 

23 vaccines for seniors described in subsection (d)’’ 

24 before the comma at the end; and 


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1 (B) by adding at the end the following new 

2 subsection: 

3 ‘‘(d) The notice provided under subsection (a) shall 

4 include information with respect to vaccines for seniors, 

5 including information with respect to coverage of the shin6 gles vaccine under part D for individuals enrolled in a pre7 scription drug plan under such part.’’. 

8 (2) EFFECTIVE DATE.—The amendments made 

9 by this subsection shall apply to notices distributed 

10 prior to each Medicare open enrollment period begin11 ning after the date of implementation of section 

12 1860D–2(b)(8), as added by subsection (b)(2). 

13 (b) COVERAGE OF THE SHINGLES VACCINE UNDER

14 MEDICARE PART D.— 

15 (1) PROVISION OF EDUCATIONAL MATERIALS

16 REGARDING THE AVAILABILITY OF ACIP-REC17 OMMENDED HERPES VACCINE WITH NO COST SHAR18 ING.—Section 1860D–4(a)(1)(B) of the Social Secu19 rity Act (42 U.S.C. 1395w–104(a)(1)(B)) is amend20 ed by adding at the end the following new clause: 

21 ‘‘(vi) For plan years beginning on or 

22 after January 1 of the first year beginning 

23 more than 60 days after the date of the 

24 enactment of this clause, information reVerDate Sep 11 2014 04:11 Nov 10, 2017 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4297.IH H4297

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1 garding access to the shingles vaccine with 

2 no cost sharing under the plan.’’. 

3 (2) ENSURING TREATMENT OF COST SHARING

4 IS CONSISTENT WITH TREATMENT OF VACCINES

5 UNDER MEDICARE PART B.—Section 1860D–2(b) of 

6 the Social Security Act (42 U.S.C. 1395w–102(b)) is 

7 amended— 

8 (A) in paragraph (1)(A), by striking ‘‘The 

9 coverage’’ and inserting ‘‘Subject to paragraph 

10 (8), the coverage’’; 

11 (B) in paragraph (2)(A), by striking ‘‘and 

12 (D)’’ and inserting ‘‘and (D) and paragraph 

13 (8)’’; 

14 (C) in paragraph (3)(A), by striking ‘‘and 

15 (4)’’ and inserting ‘‘(4), and (8)’’; 

16 (D) in paragraph (4)(A)(i), by striking 

17 ‘‘The coverage’’ and inserting ‘‘Subject to para18 graph (8), the coverage’’; and 

19 (E) by adding at the end the following new 

20 paragraph: 

21 ‘‘(8) TREATMENT OF COST SHARING FOR SHIN22 GLES VACCINE CONSISTENT WITH TREATMENT OF

23 VACCINES UNDER PART B.—For plan years begin24 ning on or after January 1 of the first year beginVerDate Sep 11 2014 04:11 Nov 10, 2017 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4297.IH H4297

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1 ning more than 60 days after the date of the enact2 ment of this paragraph: 

3 ‘‘(A) NO APPLICATION OF DEDUCTIBLE.— 

4 The deductible under paragraph (1) shall not 

5 apply with respect to the shingles vaccine. 

6 ‘‘(B) NO APPLICATION OF COINSUR7 ANCE.—There shall be no coinsurance under 

8 paragraph (2) with respect to the shingles vac9 cine. 

10 ‘‘(C) NO APPLICATION OF INITIAL COV11 ERAGE LIMIT.—The initial coverage limit under 

12 paragraph (3) shall not apply with respect to 

13 the shingles vaccine. 

14 ‘‘(D) NO COST SHARING ABOVE ANNUAL

15 OUT-OF-POCKET THRESHOLD.—There shall be 

16 no cost sharing under paragraph (4) with re17 spect to the shingles vaccine.’’. 

18 (3) CONFORMING AMENDMENTS TO COST SHAR19 ING FOR LOW-INCOME INDIVIDUALS.—Section 

20 1860D–14(a) of the Social Security Act (42 U.S.C. 

21 1395w–114(a)) is amended— 

22 (A) in paragraph (1)(D), in each of clauses 

23 (ii) and (iii), by striking ‘‘In the case’’ and in24 serting ‘‘Subject to paragraph (6), in the case’’; 

25 (B) in paragraph (2)— 


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1 (i) in subparagraph (D), by striking 

2 ‘‘The substitution’’ and inserting ‘‘Subject 

3 to paragraph (6), the substitution’’; and 

4 (ii) in subparagraph (E), by striking 

5 ‘‘subsection (c)’’ and inserting ‘‘paragraph 

6 (6) and subsection (c)’’; and 

7 (C) by adding at the end the following new 

8 paragraph: 

9 ‘‘(6) NO APPLICATION OF COST SHARING FOR

10 SHINGLES VACCINE.—Consistent with section 

11 1860D–2(b)(8), for plan years beginning on or after 

12 January 1 of the first year beginning more than 60 

13 days after the date of the enactment of this para14 graph, there shall be no cost sharing under this sec15 tion with respect to the shingles vaccine.’’. 

16 (c) STUDY AND REPORT.— 

17 (1) STUDY.—The Secretary of Health and 

18 Human Services (referred to in this subsection as 

19 the ‘‘Secretary’’), acting through the Director of the 

20 Centers for Disease Control and Prevention, in col21 laboration with the Administrator of the Centers for 

22 Medicare & Medicaid Services, shall conduct a study 

23 on the uptake of vaccines, including the herpes 

24 zoster vaccine and the tetanus, diphtheria, and per25 tussis vaccine, and anticipated vaccines against such 


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1 diseases as respiratory syncytial virus, clostridium 

2 difficile, and others. Such study shall include an 

3 analysis of ways to— 

4 (A) increase the baseline target rate of 

5 coverage for currently recommended vaccines, 

6 such as herpes zoster vaccine coverage in the 

7 Healthy People 2030 goals; 

8 (B) ensure that the baseline target focuses 

9 on reducing racial and socio-economic dispari10 ties in the vaccine coverage rates for all adult 

11 vaccines, including the herpes zoster vaccine; 

12 and 

13 (C) help facilitate vaccination for Medicare 

14 beneficiaries for vaccines recommended by the 

15 Centers for Disease Control and Prevention 

16 both currently and in the future, by developing 

17 and evaluating a specific set of actions that will 

18 address physician and health care provider ad19 ministrative challenges, such as difficulty 

20 verifying beneficiary coverage and complexity of 

21 physician office billing of vaccines covered 

22 under Medicare part D, that impact access for 

23 beneficiaries. 

24 (2) REPORT.—Not later than 2 years after the 

25 date of enactment of this Act, the Secretary shall 


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1 submit to Congress a report containing the results 

2 of the study under paragraph (1), together with rec3 ommendations for such legislation and administra4 tive action as the Secretary determines appropriate. 

Æ 


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