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Medicare Part D enrollee savings from elimination of vaccine cost-sharing
Medicare Part D enrollee savings from elimination of vaccine cost-sharing
- Collection:
- Health Policy and Services Research
- Series Title(s):
- ASPE issue brief and Inflation Reduction Act research series
- Author(s):
- Sayed, Bisma A., author
Finegold, Kenneth, 1957- author
Ashok, Kaavya, author
Schutz, Sarah, author
De Lew, Nancy, author
Sheingold, Steven, author
Sommers, Benjamin D., author - Contributor(s):
- United States. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. Office of Health Policy, issuing body.
- Publication:
- Washington, D.C. : Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, March 15, 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Cost Savings
Cost Sharing -- economics
Medicare Part D -- economics
Vaccines -- economics
United States
United States. - Genre(s):
- Technical Report
- Abstract:
- As of January 1, 2023, the Inflation Reduction Act eliminated out-of-pocket costs for vaccines covered under Medicare Part D that are recommended by the Advisory Committee on Immunization Practices (ACIP). Currently, about 51 million Medicare beneficiaries are enrolled in a Part D plan. We examined vaccine use, total costs, and out-of-pocket spending for vaccines covered under Part D, including vaccines to prevent herpes zoster (shingles); tetanus and diphtheria (Td); tetanus, diphtheria, and pertussis (Tdap); hepatitis A; and hepatitis B. About 3.4 million (7 percent) of Medicare Part D enrollees received a Part D covered vaccine, paying a total of $234 million in out-of-pocket costs in 2021, or approximately $70 per beneficiary. The majority of enrollees who received a vaccine were immunized with the shingles vaccine (82 percent) with each patient paying an average of $77 in out-of-pocket costs, followed by the Tdap vaccine (21 percent) with each patient paying an average of $28 in out-of-pocket costs. There was variation around the average out-of-pocket costs with enrollees in the top 10 percent of costs paying $193 or higher for the shingles vaccine and $66 or higher for the Tdap vaccine. In addition, on average, enrollees paid $20 out-of-pocket for the Td vaccine, $34 for the hepatitis A vaccine, and $51 for the hepatitis B vaccine. There was variation around the average with enrollees in the top 10 percent of out-of-pocket costs paying $56 or higher for the Td vaccine, $97 or higher for the hepatitis A vaccine, and $139 or higher for the hepatitis B vaccine. Enrollees without the Part D low-income subsidy (LIS) generally have the highest cost burden for prescription drugs, including vaccines. Non-LIS enrollees paid on average $86 per enrollee in 2021 for Part D vaccines, driven largely by the shingles vaccine. If the new vaccine provisions had been in effect in 2021, they would have resulted in cost-sharing savings across a wide range of demographic groups, including 2.7 million White enrollees, 271,000 Black enrollees, 113,000 Asian enrollees, and 86,000 Latino enrollees. Improved affordability may also reduce existing racial and ethnic disparities in access to these vaccines. State-level estimates show that California ($20,000,000), Florida ($18,000,000), and Texas ($14,000,000) had the highest total beneficiary out-of-pocket costs for all Part D vaccines.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (27 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918627786706676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918627786706676