Every fall between Oct. 15 and Dec. 7, 48.7 million Americans sit down at their kitchen tables to decide which Medicare prescription drug plan they should choose to cover their medications. More than 300,000 of our fellow West Virginians are among them.
For many, it is an agonizing process because of the complicated and costly landscape. Starting Jan. 1, 2023, there will be one less cost to worry about — vaccines under Medicare will be free of cost.
We welcome this change. As pharmacists, unfortunately, far too often, we see seniors decide not to get vaccinated because of a higher copay that their Medicare Part D health plans require at the pharmacy.
Every year, thousands of adults die and thousands more suffer serious health problems from vaccine-preventable diseases like the flu, pneumonia, shingles and tetanus, diphtheria and pertussis (or whooping cough).
While Medicare Part B covers vaccinations to protect against influenza, pneumococcal and hepatitis B at no cost, Medicare Part D covers all other CDC-recommended vaccines, including those for shingles (Zoster) and whooping cough (Tdap), and, until now, they were costing beneficiaries as much as $160 per vaccine.
Research shows that, when Americans must pay for their vaccines, they are less likely to be vaccinated. Nationwide, 70% of adults age 65 and older get vaccinated for flu (free under Medicare Part B) while only 37% get a shingles vaccine (with copay under Medicare Part D). In West Virginia, only about 25% of older adults are getting a shingles vaccine.
Vaccines are especially important for older adults, because a healthy person’s ability to fight off infection weakens over time. Adults age 50 and older are particularly susceptible to vaccine-preventable disease, and they account for a disproportionate number of serious illnesses and deaths. Copays and coinsurance on vaccines not only place an unnecessary financial burden on those living with fixed incomes but also put the health of millions of Americans needlessly at risk.
We know that our patients in West Virginia want to make good decisions for themselves and their families. By removing these cost barriers, 319,000 Medicare Part D recipients in West Virginia alone will have a greater opportunity to avoid getting sick or dying from diseases that a simple — and free — shot could prevent.
Our economy could get a boost, too: Not only will adults be protected from significant health care expenses associated with these diseases, but the United States also could save billions in treatment costs.
It’s taken years to get here, with tireless efforts from so many, including Sen. Shelley Moore Capito, R-W.Va., who supported the Protecting Seniors Through Immunization Act. Thanks to this persistence, our patients do not have to decide between good health or paying for their basic, day-to-day living needs.
As pharmacists, we want to first prevent all of the disease that we can and then focus on treating illnesses as they occur. But there’s still work to do. Ensuring that our seniors in West Virginia have affordable access to these lifesaving vaccines is one step in ensuring that our state’s most vulnerable are also among the most protected.
We also have a responsibility to make sure people know about this new benefit: Pharmacists and physicians need to share this important news with their patients and be prepared for an increase in demand; and health insurance plans and public health officials need to launch information campaigns in communities across our state.
This is an investment in the future health, well-being and economic security of our seniors and our larger community’s public health.
Gretchen Kreckel Garofoli and Betsy Elswick are pharmacists and clinical associate professors at West Virginia University’s School of Pharmacy.
