I 
116TH CONGRESS 
1ST SESSION H. R. 5076 
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 13, 2019 
Ms. SHALALA (for herself, Mr. BUCSHON, Ms. KUSTER of New Hampshire, 
and Mr. DAVID P. ROE of Tennessee) 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 provi-
sions 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protecting Seniors 
Through Immunization Act of 2019’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) The immune system deteriorates with age, 
leaving older adults more susceptible to many vac-
cine-preventable diseases that could result in hos-
pitalizations and other costly medical interventions. 
(2) Vaccines play an essential role in preventing 
disease, thereby helping to keep older adults active 
and independent. 
(3) There are more than a dozen immunizations 
recommended for adult populations by the Advisory 
Committee on Immunization Practices of the Cen-
ters for Disease Control and Prevention, including— 
(A) influenza; 
(B) tetanus, diphtheria, pertussis (Tdap); 
(C) measles, mumps, rubella (MMR); 
(D) herpes zoster (shingles); 
(E) human papillomavirus (HPV); 
(F) pneumococcal; 
(G) hepatitis A; 
(H) hepatitis B; and 
(I) meningococcal. 
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(4) Through new research and technology, addi-
tional vaccines may be approved for older adults. 
(5) Although immunizations are lifesaving and 
cost-effective interventions, adult vaccination rates 
in the United States remain below Federal Healthy 
People benchmarks. 
(6) There are disparities in adult vaccination 
rates across different races and ethnicities with rates 
generally lower among Hispanics, African Ameri-
cans, and Asian Americans. 
(7) Important vaccines, including those for 
shingles and Tdap, are covered under the Medicare 
Prescription Drug Program under part D of title 
XVIII of the Social Security Act. Coverage under 
the Medicare part D has resulted in barriers to opti-
mal and consistent uptake, including lack of patient 
and provider awareness, beneficiary cost sharing, 
and low provider reimbursement, as well as geo-
graphic, cultural, and linguistic challenges. 
(8) The Advisory Committee on Immunization 
Practices of the Centers for Disease Control and 
Prevention recommends the Tdap vaccine should be 
administered every 10 years for all ages. According 
to the Centers for Disease Control and Prevention 
Surveillance of Vaccination Coverage Among Adults 
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in the United States, National Health Interview Sur-
vey, 2016, vaccination rates remain low for tetanus 
and diphtheria (Td) and tetanus and diphtheria with 
acellular pertussis (Tdap) for adults age 65 and 
older, at 58 percent and 20 percent respectively. 
(9) Being up-to-date with Tdap is especially im-
portant for adults who are around babies, because 
they are not only protecting their own health but 
helping to form a ‘‘cocoon’’ of disease protection 
around the baby during the first few months of life. 
(10) The Advisory Committee on Immunization 
Practices of the Centers for Disease Control and 
Prevention recommends the shingles vaccine for indi-
viduals aged 50 and older. While vaccine coverage 
for shingles has increased each year since licensure, 
in 2016, only 33 percent of adults over 60 years re-
ported receiving the vaccine. 
(11) Almost 1 out of every 3 people in the 
United States will develop shingles in their lifetime. 
The risk increases with age, and older individuals 
are much more likely to experience postherpetic neu-
ralgia non-pain complications, hospitalizations, and 
interference with activities of daily living, such as 
eating, dressing, and bathing. 
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(12) A 2018 study of Tdap and shingles vaccine 
claims in Medicare part D demonstrated that higher 
out-of-pocket cost sharing was associated with high-
er rates of cancelled vaccination claims, suggesting 
vaccination was abandoned. In this study, cost shar-
ing of $51 or greater was associated with a 2 to 2.7- 
times greater rate of cancelled vaccination claims 
compared with $0 cost sharing. 
(13) There is an opportunity to improve edu-
cation around adult immunization, including the 
risks and consequences of vaccine-preventable dis-
ease, and which vaccines are recommended for older 
adults. 
SEC. 3. PROVISION OF INFORMATION REGARDING VAC-
CINES FOR SENIORS AS PART OF MEDICARE 
& YOU HANDBOOK AND COVERAGE OF ADULT 
VACCINES RECOMMENDED BY THE ADVISORY 
COMMITTEE ON IMMUNIZATION PRACTICES 
UNDER MEDICARE PART D. 
(a) PROVISION OF INFORMATION REGARDING VAC-
CINES
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— 
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(A) in subsection (a)(1), by inserting ‘‘, in-
cluding information with respect to coverage of 
vaccines for seniors described in subsection (e)’’ 
before the comma at the end; and 
(B) by adding at the end the following new 
subsection: 
‘‘(e) The notice provided under subsection (a) shall 
include information with respect to vaccines for seniors, 
including information with respect to coverage of adult 
vaccines recommended by the Advisory Committee on Im-
munization Practices (as defined in section 1860D– 
2(b)(8)(B)) under part D for individuals enrolled in a pre-
scription 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 begin-
ning after the date of implementation of section 
1860D–2(b)(8), as added by subsection (b)(2). 
(b) COVERAGE OF ADULT VACCINES RECOMMENDED 
BY THE ADVISORY COMMITTEE ON IMMUNIZATION PRAC-
TICES UNDER MEDICARE PART D.— 
(1) PROVISION
OF
EDUCATIONAL
MATERIALS 
REGARDING THE AVAILABILITY OF ADULT VACCINES 
RECOMMENDED BY THE ADVISORY COMMITTEE ON 
IMMUNIZATION
PRACTICES
WITH
NO
COST
SHAR-
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