I 
117TH CONGRESS 
1ST SESSION H. R. 1978 
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 
MARCH 17, 2021 
Ms. KUSTER (for herself and Mr. BUCSHON) 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 subse-
quently 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. 
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 2021’’. 
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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ING.—Section 1860D–4(a)(1)(B) of the Social Secu-
rity Act (42 U.S.C. 1395w–104(a)(1)(B)) is amend-
ed by adding at the end the following new clause: 
‘‘(vii) 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 re-
garding access to adult vaccines rec-
ommended by the Advisory Committee on 
Immunization Practices (as defined in sec-
tion 1860D–2(b)(8)(B)).’’. 
(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)’’; 
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(D) in paragraph (4)(A)(i), by striking 
‘‘The coverage’’ and inserting ‘‘Subject to para-
graph (8), the coverage’’; and 
(E) by adding at the end the following new 
paragraph: 
‘‘(8) TREATMENT
OF
COST
SHARING
FOR 
ADULT VACCINES RECOMMENDED BY THE ADVISORY 
COMMITTEE
ON
IMMUNIZATION
PRACTICES
CON-
SISTENT
WITH
TREATMENT
OF
VACCINES
UNDER 
PART B.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1 of the first year be-
ginning more than 60 days after the date of the 
enactment of this paragraph, the following shall 
apply with respect to an adult vaccine rec-
ommended by the Advisory Committee on Im-
munization Practices (as defined in subpara-
graph (B)): 
‘‘(i) NO
APPLICATION
OF
DEDUCT-
IBLE.—The deductible under paragraph 
(1) shall not apply with respect to such 
vaccine. 
‘‘(ii) NO
APPLICATION
OF
COINSUR-
ANCE.—There shall be no coinsurance 
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under paragraph (2) with respect to such 
vaccine. 
‘‘(iii) NO
APPLICATION
OF
INITIAL 
COVERAGE
LIMIT.—The initial coverage 
limit under paragraph (3) shall not apply 
with respect to such vaccine. 
‘‘(iv) NO COST SHARING ABOVE AN-
NUAL
OUT-OF-POCKET
THRESHOLD.— 
There shall be no cost sharing under para-
graph (4) with respect to such vaccine. 
‘‘(B) ADULT VACCINES RECOMMENDED BY 
THE ADVISORY COMMITTEE ON IMMUNIZATION 
PRACTICES.—For purposes of this paragraph, 
the term ‘adult vaccine recommended by the 
Advisory Committee on Immunization Prac-
tices’ means a vaccine approved for use by 
adult populations and in accordance with rec-
ommendations of the Advisory Committee on 
Immunization Practices of the Centers for Dis-
ease Control and Prevention.’’. 
(3) CONFORMING AMENDMENTS TO COST SHAR-
ING
FOR
LOW-INCOME
INDIVIDUALS.—Section 
1860D–14(a) of the Social Security Act (42 U.S.C. 
1395w–114(a)) is amended— 
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(A) in paragraph (1)(D), in each of clauses 
(ii) and (iii), by striking ‘‘In the case’’ and in-
serting ‘‘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 
ADULT VACCINES RECOMMENDED BY THE ADVISORY 
COMMITTEE
ON
IMMUNIZATION
PRACTICES.—Con-
sistent with section 1860D–2(b)(8), for plan years 
beginning on or after January 1 of the first year be-
ginning more than 60 days after the date of the en-
actment of this paragraph, there shall be no cost 
sharing under this section with respect to an adult 
vaccine recommended by the Advisory Committee on 
Immunization Practices (as defined in subparagraph 
(B) of such section).’’. 
(c) STUDY AND REPORT.— 
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(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, and in 
collaboration with the Administrator of the Centers 
for Medicare & Medicaid Services, shall conduct a 
study on the uptake of vaccines among the Medicare 
beneficiary population, including the herpes zoster 
vaccine and the tetanus, diphtheria, and pertussis 
vaccine, and anticipated vaccines against such dis-
eases 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 vaccines recommended by the Advi-
sory Committee on Immunization Practices of 
the Centers for Disease Control and Prevention 
in the Healthy People 2020 goals; 
(B) ensure that baseline targets focus on 
reducing racial and socioeconomic disparities in 
the vaccine coverage rates for all adult vaccines; 
(C) help facilitate immunization of Medi-
care beneficiaries, by developing and evaluating 
a specific set of actions that will address physi-
cian and health care provider administrative 
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challenges, such as difficulty verifying bene-
ficiary coverage and complexity of physician of-
fice billing of vaccines covered under Medicare 
part D, that impact access for beneficiaries; 
(D) support adoption of the HEDIS adult 
immunization status composite measure (Tdap, 
pneumococcal, influenza, and zoster) in order to 
close gaps in adult immunization performance 
measurement 
and 
incentivize 
vaccination 
through adoption of evidence-based measures; 
and 
(E) strengthen immunization information 
systems to allow all States to have electronic 
databases for immunization records. 
(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 rec-
ommendations for such legislation and administra-
tive action as the Secretary determines appropriate. 
Æ 
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