II 

117TH CONGRESS 

1ST SESSION S. 912 

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 SENATE OF THE UNITED STATES 

MARCH 23, 2021 

Ms. HIRONO (for herself, Mrs. CAPITO, Mr. WHITEHOUSE, and Mr. SCOTT of 

South Carolina) introduced the following bill; which was read twice and 

referred to the Committee on Finance 

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, 

3 SECTION 1. SHORT TITLE. 

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

5 Through Immunization Act of 2021’’. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) The immune system deteriorates with age, 

4 leaving older adults more susceptible to many vac5 cine-preventable diseases that could result in hos6 pitalizations and other costly medical interventions. 

7 (2) Vaccines play an essential role in preventing 

8 disease, thereby helping to keep older adults active 

9 and independent. 

10 (3) There are more than a dozen immunizations 

11 recommended for adult populations by the Advisory 

12 Committee on Immunization Practices of the Cen13 ters for Disease Control and Prevention, including— 

14 (A) influenza; 

15 (B) tetanus, diphtheria, pertussis (Tdap); 

16 (C) measles, mumps, rubella (MMR); 

17 (D) herpes zoster (shingles); 

18 (E) human papillomavirus (HPV); 

19 (F) pneumococcal; 

20 (G) hepatitis A; 

21 (H) hepatitis B; and 

22 (I) meningococcal. 

23 (4) Through new research and technology, addi24 tional vaccines may be approved for older adults. 

25 (5) Although immunizations are lifesaving and 

26 cost-effective interventions, adult vaccination rates 


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1 in the United States remain below Federal Healthy 

2 People benchmarks. 

3 (6) There are disparities in adult vaccination 

4 rates across different races and ethnicities with rates 

5 generally lower among Hispanics, African Ameri6 cans, and Asian Americans. 

7 (7) Important vaccines, including those for 

8 shingles and Tdap, are covered under the Medicare 

9 Prescription Drug Program under part D of title 

10 XVIII of the Social Security Act. Coverage under 

11 the Medicare part D has resulted in barriers to opti12 mal and consistent uptake, including lack of patient 

13 and provider awareness, beneficiary cost sharing, 

14 and low provider reimbursement, as well as geo15 graphic, cultural, and linguistic challenges. 

16 (8) The Advisory Committee on Immunization 

17 Practices of the Centers for Disease Control and 

18 Prevention recommends the Tdap vaccine should be 

19 administered every 10 years for all ages. According 

20 to the Centers for Disease Control and Prevention 

21 Surveillance of Vaccination Coverage Among Adults 

22 in the United States, National Health Interview Sur23 vey, 2016, vaccination rates remain low for tetanus 

24 and diphtheria (Td) and tetanus and diphtheria with 


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1 acellular pertussis (Tdap) for adults age 65 and 

2 older, at 58 percent and 20 percent respectively. 

3 (9) Being up-to-date with Tdap is especially im4 portant for adults who are around babies, because 

5 they are not only protecting their own health but 

6 helping to form a ‘‘cocoon’’ of disease protection 

7 around the baby during the first few months of life. 

8 (10) The Advisory Committee on Immunization 

9 Practices of the Centers for Disease Control and 

10 Prevention recommends the shingles vaccine for indi11 viduals aged 50 and older. While vaccine coverage 

12 for shingles has increased each year since licensure, 

13 in 2016, only 33 percent of adults over 60 years re14 ported receiving the vaccine. 

15 (11) Almost 1 out of every 3 people in the 

16 United States will develop shingles in their lifetime. 

17 The risk increases with age, and older individuals 

18 are much more likely to experience postherpetic neu19 ralgia non-pain complications, hospitalizations, and 

20 interference with activities of daily living, such as 

21 eating, dressing, and bathing. 

22 (12) A 2018 study of Tdap and shingles vaccine 

23 claims in Medicare part D demonstrated that higher 

24 out-of-pocket cost-sharing was associated with high25 er rates of cancelled vaccination claims, suggesting 


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1 vaccination was abandoned. In this study, cost-shar2 ing of $51 or greater was associated with a 2 to 2.7- 

3 times greater rate of cancelled vaccination claims 

4 compared with $0 cost-sharing. 

5 (13) There is an opportunity to improve edu6 cation around adult immunization, including the 

7 risks and consequences of vaccine-preventable dis8 ease, and which vaccines are recommended for older 

9 adults. 

10 SEC. 3. PROVISION OF INFORMATION REGARDING VAC11 CINES FOR SENIORS AS PART OF MEDICARE 

12 & YOU HANDBOOK AND COVERAGE OF ADULT 

13 VACCINES RECOMMENDED BY THE ADVISORY 

14 COMMITTEE ON IMMUNIZATION PRACTICES 

15 UNDER MEDICARE PART 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 (e)’’ 

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 ‘‘(e) The notice provided under subsection (a) shall 

4 include information with respect to vaccines for seniors, 

5 including information with respect to coverage of adult 

6 vaccines recommended by the Advisory Committee on Im7 munization Practices (as defined in section 1860D– 

8 2(b)(8)(B)) under part D for individuals enrolled in a pre9 scription drug plan under such part.’’. 

10 (2) EFFECTIVE DATE.—The amendments made 

11 by this subsection shall apply to notices distributed 

12 prior to each Medicare open enrollment period begin13 ning after the date of implementation of section 

14 1860D–2(b)(8), as added by subsection (b)(2). 

15 (b) COVERAGE OF ADULT VACCINES RECOMMENDED

16 BY THE ADVISORY COMMITTEE ON IMMUNIZATION PRAC17 TICES UNDER MEDICARE PART D.— 

18 (1) PROVISION OF EDUCATIONAL MATERIALS

19 REGARDING THE AVAILABILITY OF ADULT VACCINES

20 RECOMMENDED BY THE ADVISORY COMMITTEE ON

21 IMMUNIZATION PRACTICES WITH NO COST SHAR22 ING.—Section 1860D–4(a)(1)(B) of the Social Secu23 rity Act (42 U.S.C. 1395w–104(a)(1)(B)) is amend24 ed by adding at the end the following new clause: 


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1 ‘‘(vii) For plan years beginning on or 

2 after January 1 of the first year beginning 

3 more than 60 days after the date of the 

4 enactment of this clause, information re5 garding access to adult vaccines rec6 ommended by the Advisory Committee on 

7 Immunization Practices (as defined in sec8 tion 1860D–2(b)(8)(B)).’’. 

9 (2) ENSURING TREATMENT OF COST SHARING

10 IS CONSISTENT WITH TREATMENT OF VACCINES

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

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

13 amended— 

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

15 coverage’’ and inserting ‘‘Subject to paragraph 

16 (8), the coverage’’; 

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

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

19 (8)’’; 

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

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

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

23 ‘‘The coverage’’ and inserting ‘‘Subject to para24 graph (8), the coverage’’; and 


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

2 paragraph: 

3 ‘‘(8) TREATMENT OF COST SHARING FOR

4 ADULT VACCINES RECOMMENDED BY THE ADVISORY

5 COMMITTEE ON IMMUNIZATION PRACTICES CON6 SISTENT WITH TREATMENT OF VACCINES UNDER

7 PART B.— 

8 ‘‘(A) IN GENERAL.—For plan years begin9 ning on or after January 1 of the first year be10 ginning more than 60 days after the date of the 

11 enactment of this paragraph, the following shall 

12 apply with respect to an adult vaccine rec13 ommended by the Advisory Committee on Im14 munization Practices (as defined in subpara15 graph (B)): 

16 ‘‘(i) NO APPLICATION OF DEDUCT17 IBLE.—The deductible under paragraph 

18 (1) shall not apply with respect to such 

19 vaccine. 

20 ‘‘(ii) NO APPLICATION OF COINSUR21 ANCE.—There shall be no coinsurance 

22 under paragraph (2) with respect to such 

23 vaccine. 

24 ‘‘(iii) NO APPLICATION OF INITIAL

25 COVERAGE LIMIT.—The initial coverage 


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1 limit under paragraph (3) shall not apply 

2 with respect to such vaccine. 

3 ‘‘(iv) NO COST SHARING ABOVE AN4 NUAL OUT-OF-POCKET THRESHOLD.— 

5 There shall be no cost sharing under para6 graph (4) with respect to such vaccine. 

7 ‘‘(B) ADULT VACCINES RECOMMENDED BY

8 THE ADVISORY COMMITTEE ON IMMUNIZATION

9 PRACTICES.—For purposes of this paragraph, 

10 the term ‘adult vaccine recommended by the 

11 Advisory Committee on Immunization Prac12 tices’ means a vaccine approved for use by 

13 adult populations and in accordance with rec14 ommendations of the Advisory Committee on 

15 Immunization Practices of the Centers for Dis16 ease Control and Prevention.’’. 

17 (3) CONFORMING AMENDMENTS TO COST SHAR18 ING FOR LOW-INCOME INDIVIDUALS.—Section 

19 1860D–14(a) of the Social Security Act (42 U.S.C. 

20 1395w–114(a)) is amended— 

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

22 (ii) and (iii), by striking ‘‘In the case’’ and in23 serting ‘‘Subject to paragraph (6), in the case’’; 

24 (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 ADULT VACCINES RECOMMENDED BY THE ADVISORY

11 COMMITTEE ON IMMUNIZATION PRACTICES.—Con12 sistent with section 1860D–2(b)(8), for plan years 

13 beginning on or after January 1 of the first year be14 ginning more than 60 days after the date of the en15 actment of this paragraph, there shall be no cost 

16 sharing under this section with respect to an adult 

17 vaccine recommended by the Advisory Committee on 

18 Immunization Practices (as defined in subparagraph 

19 (B) of such section).’’. 

20 (c) STUDY AND REPORT.— 

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

22 Human Services (referred to in this subsection as 

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

24 Centers for Disease Control and Prevention, and in 

25 collaboration with the Administrator of the Centers 


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1 for Medicare & Medicaid Services, shall conduct a 

2 study on the uptake of vaccines among the Medicare 

3 beneficiary population, including the herpes zoster 

4 vaccine and the tetanus, diphtheria, and pertussis 

5 vaccine, and anticipated vaccines against such dis6 eases as respiratory syncytial virus, clostridium 

7 difficile, and others. Such study shall include an 

8 analysis of ways to— 

9 (A) increase the baseline target rate of 

10 coverage for vaccines recommended by the Advi11 sory Committee on Immunization Practices of 

12 the Centers for Disease Control and Prevention 

13 in the Healthy People 2020 goals; 

14 (B) ensure that baseline targets focus on 

15 reducing racial and socioeconomic disparities in 

16 the vaccine coverage rates for all adult vaccines; 

17 (C) help facilitate immunization of Medi18 care beneficiaries, by developing and evaluating 

19 a specific set of actions that will address physi20 cian and health care provider administrative 

21 challenges, such as difficulty verifying bene22 ficiary coverage and complexity of physician of23 fice billing of vaccines covered under Medicare 

24 part D, that impact access for beneficiaries; 


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1 (D) support adoption of the HEDIS adult 

2 immunization status composite measure (Tdap, 

3 pneumococcal, influenza, and zoster) in order to 

4 close gaps in adult immunization performance 

5 measurement and incentivize vaccination 

6 through adoption of evidence-based measures; 

7 and 

8 (E) strengthen immunization information 

9 systems to allow all States to have electronic 

10 databases for immunization records. 

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

12 date of enactment of this Act, the Secretary shall 

13 submit to Congress a report containing the results 

14 of the study under paragraph (1), together with rec15 ommendations for such legislation and administra16 tive action as the Secretary determines appropriate. 

Æ 


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