II 

114TH CONGRESS 

2D SESSION S. 3477 

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 

NOVEMBER 17, 2016 

Ms. HIRONO (for herself and Mrs. CAPITO) 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 2016’’. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

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

4 caused by the reactivation of the varicella-zoster 

5 virus that causes chickenpox in childhood. The virus 

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

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

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

9 increase with age, but, among individuals who expe10 rience herpes zoster, older individuals are much 

11 more likely to experience postherpetic neuralgia non12 pain complications, hospitalizations, and interference 

13 with activities of daily living, such as eating, dress14 ing, and bathing. 

15 (2) Postherpetic neuralgia, a complication of 

16 shingles, occurs rarely among individuals under age 

40 but can occur in up to 1 17 ⁄3 of untreated individ18 uals age 60 and older. 

19 (3) The Food and Drug Administration ap20 proved the herpes zoster vaccine for individuals age 

21 50 and older. The Advisory Committee on Immuni22 zation Practices presently recommends the herpes 

23 zoster vaccine for all individuals age 60 and older. 

24 (4) The Healthy People 2020 target baseline 

25 for the herpes zoster vaccine is 30 percent coverage 

26 for individuals age 60 and over. This benchmark is 


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1 unfortunately low compared to that of other adult 

2 vaccines such as influenza (70 percent) and pneumo3 coccal disease (60 percent). Even at such a low tar4 get, the coverage rate is not being met. The Centers 

5 for Disease Control and Prevention reported that in 

6 2014, only 28 percent of adults age 60 and older re7 ported receiving the herpes zoster vaccine. 

8 (5) According to the 2014 National Health 

9 Interview Survey of the Centers for Disease Control 

10 and Prevention, vaccination rates for adults are 20 

11 percent for Tetanus, Diphtheria, and Pertussis, 28 

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

13 61 percent for pneumonia. There are also disparities 

14 across adult vaccination rates. Adult immunization 

15 rates are generally lower among Hispanics, African16 Americans, and Asians. 

17 (6) Medicare coverage for the herpes zoster vac18 cine under the Prescription Drug Program under 

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

20 resulted in many barriers to optimal and consistent 

21 uptake to prevent shingles and its costly and painful 

22 complications. 

23 (7) Lack of awareness and logistical and finan24 cial challenges are the most often cited reasons for 


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1 Medicare beneficiaries not being immunized against 

2 the varicella-zoster virus. 

3 (8) Herpes zoster is estimated to account for 

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

5 inpatient admissions each year. Average costs across 

6 the episode of care were $1,835 and $14,428 per pa7 tient in the outpatient and inpatient settings, respec8 tively. 

9 SEC. 3. PROVISION OF INFORMATION REGARDING VAC10 CINES FOR SENIORS AS PART OF MEDICARE 

11 & YOU HANDBOOK AND COVERAGE OF THE 

12 SHINGLES VACCINE UNDER MEDICARE PART 

13 D. 

14 (a) PROVISION OF INFORMATION REGARDING VAC15 CINES FOR SENIORS AS PART OF MEDICARE & YOU

16 HANDBOOK.— 

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

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

19 (A) in subsection (a)(1), by inserting ‘‘, in20 cluding information with respect to coverage of 

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

22 before the comma at the end; and 

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

24 subsection: 


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

2 include information with respect to vaccines for seniors, 

3 including information with respect to coverage of the shin4 gles vaccine under part D for individuals enrolled in a pre5 scription drug plan under such part.’’. 

6 (2) EFFECTIVE DATE.—The amendments made 

7 by this subsection shall apply to notices distributed 

8 prior to each Medicare open enrollment period begin9 ning after the date of implementation of section 

10 1860D–2(b)(8), as added by subsection (b)(2). 

11 (b) COVERAGE OF THE SHINGLES VACCINE UNDER

12 MEDICARE PART D.— 

13 (1) PROVISION OF EDUCATIONAL MATERIALS

14 REGARDING THE AVAILABILITY OF ACIP-REC15 OMMENDED HERPES VACCINE WITH NO COST SHAR16 ING.—Section 1860D–4(a)(1)(B) of the Social Secu17 rity Act (42 U.S.C. 1395w–104(a)(1)(B)) is amend18 ed by adding at the end the following new clause: 

19 ‘‘(v) For plan years beginning on or 

20 after January 1 of the first year beginning 

21 more than 60 days after the date of the 

22 enactment of this clause, information re23 garding access to the shingles vaccines 

24 with no cost sharing under the plan.’’. 


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1 (2) ENSURING TREATMENT OF COST SHARING

2 IS CONSISTENT WITH TREATMENT OF VACCINES

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

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

5 amended— 

6 (A) in paragraph (1)(A), by striking ‘‘the 

7 coverage’’ and inserting ‘‘Subject to paragraph 

8 (8), the coverage’’; 

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

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

11 (8)’’; 

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

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

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

15 ‘‘The coverage’’ and inserting ‘‘Subject to para16 graph (8), the coverage’’; and 

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

18 paragraph: 

19 ‘‘(8) TREATMENT OF COST SHARING FOR SHIN20 GLES VACCINE CONSISTENT WITH TREATMENT OF

21 VACCINES UNDER PART B.—For plan years begin22 ning on or after January 1 of the first year begin23 ning more than 60 days after the date of the enact24 ment of this paragraph: 


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

2 The deductible under paragraph (1) shall not 

3 apply with respect to the shingles vaccine. 

4 ‘‘(B) NO APPLICATION OF COINSUR5 ANCE.—There shall be no coinsurance under 

6 paragraph (2) with respect to the shingles vac7 cine. 

8 ‘‘(C) NO APPLICATION OF INITIAL COV9 ERAGE LIMIT.—The initial coverage limit under 

10 paragraph (3) shall not apply with respect to 

11 the shingles vaccine. 

12 ‘‘(D) NO COST SHARING ABOVE ANNUAL

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

14 no cost sharing under paragraph (4) with re15 spect to the shingles vaccine.’’. 

16 (3) CONFORMING AMENDMENTS TO COST SHAR17 ING FOR LOW-INCOME INDIVIDUALS.—Section 

18 1860D–14(a) of the Social Security Act (42 U.S.C. 

19 1395w–114(a)) is amended— 

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

21 (ii) and (iii), by striking ‘‘In the case’’ and in22 serting ‘‘Subject to paragraph (6), in the case’’; 

23 (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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