,,ii #aaeth ,,congress #ast ,session ,s4 #bajc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,november #h1 #bjag,ms4 ,hirono 7for herself and ,mrs4 ,capito7 introduced the following bill2 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 ,b1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,protecting ,seniors ,through ,immunization ,act of #bjag4 #b4 ,findings ,congress makes the following findings3 7#a7 ,herpes zoster1 also known as shingles1 is caused by the reactivation of the varicella-zoster virus that causes chickenpox in childhood4 ,the virus can reactivate later in life1 resulting in a painful1 itchy rash that can persist for weeks1 months1 or years4 ,not only does the risk of herpes zoster itself increase with age1 but1 among individuals who experience herpes zoster1 older individuals are much more likely to experience postherpetic neuralgia non-pain complications1 hospitalizations1 and interference with activities of daily living1 such as eating1 dressing1 and bathing4 7#b7 ,postherpetic neuralgia1 a complication of shingles1 occurs rarely among individuals under age #dj but can occur in up to #a_/c of untreated individuals age #fj and older4 7#c7 ,the ,food and ,drug ,administration approved the herpes zoster vaccine for individuals age #ej and older4 ,the ,advisory ,committee on ,immunization ,practices presently recommends the herpes zoster vaccine for all individuals age #fj and older4 7#d7 ,the ,healthy ,people #bjbj target baseline for the herpes zoster vaccine is #cj percent coverage for individuals age #fj and over4 ,this benchmark is unfortunately low compared to that of other adult vaccines such as influenza 7#gj percent7 and pneumococcal disease 7#fj percent74 ,even at such a low target1 the coverage rate is not being met4 ,the ,centers for ,disease ,control and ,prevention reported that in #bjad1 only #bh percent of adults age #fj and older reported receiving the herpes zoster vaccine4 7#e7 ,according to the #bjad ,national ,health ,interview ,survey of the ,centers for ,disease ,control and ,prevention1 vaccination rates for adults are #bj percent for ,tetanus1 ,diphtheria1 and ,pertussis1 #bh percent for shingles1 #bd percent for ,hepatitis ,b1 and #fa percent for pneumonia4 ,there are also disparities across adult vaccination rates4 ,adult immunization rates are generally lower among ,hispanics1 ,african ,americans1 and ,asians4 7#f7 ,medicare coverage for the herpes zoster vaccine under the ,prescription ,drug ,program under part ,d of title ,,xviii of the ,social ,security ,act has resulted in many barriers to optimal and consistent uptake to prevent shingles and its costly and painful complications4 7#g7 ,lack of awareness and logistical and financial challenges are the most often cited reasons for ,medicare beneficiaries not being immunized against the varicella-zoster virus4 7#h7 ,herpes zoster is estimated to account for more than #hg1jjj emergency room visits and #bh1jjj inpatient admissions each year4 ,average costs across the episode of care were #a1hce and #ad1dbh per patient in the outpatient and inpatient settings1 respectively4 #c4 ,provision of information regarding vaccines for seniors as part of ,medicare ,you handbook and coverage of the shingles vaccine under ,medicare part ,d 7a7 ,provision of information regarding vaccines for seniors as part of ,medicare ,you handbook 7#a7 ,in general ,section #ahjd of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is amended-- 7,a7 in subsection 7a77#a71 by inserting 1 including information with respect to coverage of vaccines for seniors described in subsection 7d7 before the comma at the end2 and 7,b7 by adding at the end the following new subsection3 7d7 ,the notice provided under subsection 7a7 shall include information with respect to vaccines for seniors1 including information with respect to coverage of the shingles vaccine under part ,d for individuals enrolled in a prescription drug plan under such part4 4 7#b7 ,effective date ,the amendments made by this subsection shall apply to notices distributed prior to each ,medicare open enrollment period beginning after the date of implementation of section #ahfj;,d-#b7;b77#h71 as added by subsection 7b77#b74 7b7 ,coverage of the shingles vaccine under ,medicare part ,d 7#a7 ,provision of educational materials regarding the availability of ,,acip-recommended herpes vaccine with no cost sharing ,section #ahfj;,d-#d7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;a77#a77;,b77 is amended by adding at the end the following new clause3 7v7 ,for plan years beginning on or after ,january #a of the first year beginning more than #fj days after the date of the enactment of this clause1 information regarding access to the shingles vaccines with no cost sharing under the plan4 4 7#b7 ,ensuring treatment of cost sharing is consistent with treatment of vaccines under ,medicare part ,b ,section #ahfj;,d-#b7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;b77 is amended-- 7,a7 in paragraph 7#a77;,a71 by striking the coverage and inserting ,subject to paragraph 7#h71 the coverage2 7,b7 in paragraph 7#b77;,a71 by striking and 7,d7 and inserting and 7,d7 and paragraph 7#h72 7,c7 in paragraph 7#c77;,a71 by striking and 7#d7 and inserting 7#d71 and 7#h72 7,d7 in paragraph 7#d77;,a77i71 by striking ,the coverage and inserting ,subject to paragraph 7#h71 the coverage2 and 7,e7 by adding at the end the following new paragraph3 7#h7 ,treatment of cost sharing for shingles vaccine consistent with treatment of vaccines under part ,b ,for plan years beginning on or after ,january #a of the first year beginning more than #fj days after the date of the enactment of this paragraph3 7,a7 ,no application of deductible ,the deductible under paragraph 7#a7 shall not apply with respect to the shingles vaccine4 7,b7 ,no application of coinsurance ,there shall be no coinsurance under paragraph 7#b7 with respect to the shingles vaccine4 7,c7 ,no application of initial coverage limit ,the initial coverage limit under paragraph 7#c7 shall not apply with respect to the shingles vaccine4 7,d7 ,no cost sharing above annual out-of-pocket threshold ,there shall be no cost sharing under paragraph 7#d7 with respect to the shingles vaccine4 4 7#c7 ,conforming amendments to cost sharing for low-income individuals ,section #ahfj;,d-#ad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is amended-- 7,a7 in paragraph 7#a77;,d71 in each of clauses 7ii7 and 7iii71 by striking ,in the case and inserting ,subject to paragraph 7#f71 in the case2 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,d71 by striking ,the substitution and inserting ,subject to paragraph 7#f71 the substitution2 and 7ii7 in subparagraph 7,e71 by striking subsection 7c7 and inserting paragraph 7#f7 and subsection 7c72 and 7,c7 by adding at the end the following new paragraph3 7#f7 ,no application of cost sharing for shingles vaccine ,consistent with section #ahfj;,d-#b7;b77#h71 for plan years beginning on or after ,january #a of the first year beginning more than #fj days after the date of the enactment of this paragraph1 there shall be no cost sharing under this section with respect to the shingles vaccine4 4 7c7 ,study and report 7#a7 ,study ,the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary71 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall conduct a study on the uptake of vaccines1 including the herpes zoster vaccine and the tetanus1 diphtheria1 and pertussis vaccine1 and anticipated vaccines against such diseases as respiratory syncytial virus1 clostridium difficile1 and others4 ,such study shall include an analysis of ways to-- 7,a7 increase the baseline target rate of coverage for currently recommended vaccines1 such as herpes zoster vaccine coverage in the ,healthy ,people #bjcj goals2 7,b7 ensure that the baseline target focuses on reducing racial and socio-economic disparities in the vaccine coverage rates for all adult vaccines1 including the herpes zoster vaccine2 and 7,c7 help facilitate vaccination for ,medicare beneficiaries for vaccines recommended by the ,centers for ,disease ,control and ,prevention both currently and in the future1 by developing and evaluating a specific set of actions that will address physician and health care provider administrative challenges1 such as difficulty verifying beneficiary coverage and complexity of physician office billing of vaccines covered under ,medicare part ,d1 that impact access for beneficiaries4 7#b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report containing the results of the study under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4