A summary of presentations from the weekly Summit partner webinars
August 25, 2022 – The latest Summit Summary
- Inflation Reduction Act Update – Lisa Foster (AVAC)
- Vaccine Track Portal Update – Kate Hashey (GSK), Chip Schaible (IQVIA), and Brad Burdette (IQVIA)
- Announcements
Inflation Reduction Act Update – Lisa Foster (AVAC)
Lisa Foster manages the Adult Vaccine Access Coalition (AVAC), an organization that works in the federal policy space around access and utilization of adult vaccines. Lisa’s presentation included an update on two pieces of bipartisan legislation to close the gaps in vaccine coverage that AVAC and Summit partners had been documenting and working on for a number of years.
Biden signed the Inflation Reduction Act into law earlier this month, which contained two pieces of vaccine-related legislation in the broader package.
The first piece of legislation involves Medicare and is called “Protecting Seniors through Immunity Act.”
This act is aimed at getting out of the disparity that impacted beneficiaries at the point of care. Influenza and pneumococcal vaccines were covered under physician benefit Part B of Medicare with no cost-sharing to the beneficiary. Any other vaccine that was approved by the FDA, recommended by the CDC, and aimed at those age 65+, typically falls into the pharmacy (prescription drug) benefit under Medicare Part D. Part D vaccines are subject to co-pays and cost-sharing. The cost could be over $100 for a shingles vaccine, for example, depending on the Part D plan. Financial barriers have kept those on a fixed income from seeking access to Part D vaccines and therefore, many on Medicare are not taking preventive measures to protect their health.
The “Protecting Seniors through Immunity Act” provides coverage and eliminates cost sharing under Medicare Part D. The act says that any vaccine covered under part D should be treated the same way as if it were under part B, with no cost to the beneficiary. This will take effect starting in January 2023. AVAC plans to be working closely with the administration to ensure that the provisions are implemented as efficiently as possible.
The second piece of legislation is called “Helping Adults Protect Immunity (HAPI).”
When the Affordable Care Act passed in 2010, changes made to benefits included the inclusion of vaccines with no cost sharing within commercial plans and those who were covered under a new expanded benefit in Medicaid. Not all states eliminated vaccine costs for consumers, however, or continued to offer very low vaccine and/or vaccine administration payments for providers in some states to vaccinate Medicaid patients. Specifically, there was a gap in coverage with the traditional Medicaid program, so the ability to access a vaccine depended on what state you lived in, the terms of your plan, and your copay. Providers were being reimbursed at various rates for vaccine administration and in some states providers lost money when giving a vaccine to a Medicaid patient, which reduced the incentive to serve the Medicaid population.
HAPI helps provide vaccine coverage across all states and improve vaccine access for Medicaid patients. The Medicaid vaccine provisions from the HAPI act will take effect in January 1, 2023.
Check out AVAC’s resources and social media tool kit at: www.adultvaccinesnow.org
Questions
Q: Do you plan on developing materials and/or educational webinars on the new legislation?
Lisa Foster: We have some resources on our website: www.adultvaccinesnow.org. We have some social media tools, are in the process of developing some op-eds, and additional education materials as this provision gets implemented. Stay tuned for more. We will continue to keep the resources updated.
Q: Will states have to create formularies or will they be required to cover all ACIP recommended vaccines if multiple vaccines are recommended? Will the formularies be vaccine brand-specific? For example, there are several different influenza vaccine products. Will all be covered or can the state pick specific brands?
Lisa Foster: The law as it’s written doesn’t specify how the vaccines need to be covered. We will be closely involved as it gets implemented. It does specify that they have to be ACIP-recommended vaccines but doesn’t go into that level of detail regarding brand. These are things we want to be monitoring very closely as these regulations roll out.
Q: When does each provision go into effect?
Lisa Foster: The Medicare provision takes effect on January 1, 2023. The Medicaid provision is on a similar timeline.
Q: Any comments on Vaccines for Adults?
Lisa Foster: We have been talking about it internally for some time. Our approach as the AVAC coalition is to tackle one bill at a time. We are really happy that we have been able to now get the Medicare/Medicaid challenges addressed and we will continue to work on those, but I think we are ready and eager to pivot to getting more deeply emersed in some of the Vaccines for Adults issues. That’s the last frontier of coverage for adults. We will be relying heavily on the Summit and partners to help inform and educate.
Carolyn Bridges (Immunize.org): One other huge benefit from what you have accomplished is that one of the challenges that many of the immunization programs have had is that if someone had Medicare part D, even if the copay was high for a vaccine, the states weren’t able to use their 317 funding for that person because they were technically considered to be covered. This will really help our immunization programs be able to get more people vaccinated who are uninsured and don’t fall into this group. CMS webinar really encouraged partners to encourage everyone to look at the new options for insurance on the exchange during open enrollment.
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Vaccine Track Portal Update – Kate Hashey (GSK), Chip Schaible (IQVIA), and Brad Burdette (IQVIA)
Kate Hashey, Director, US Vaccine Policy, GSK; Chip Schaible, Director of Business Development, IQVIA; and Brad Burdette, Engagement Manager (Data Lead), IQVIA spoke about GSK and IQVIA’s Vaccine Track portal.
Kate Hashey (GSK)
Vaccine Track is a new tool that GSK and IQVIA have been developing over the last year. With COVID-19, the world watched real-time vaccination data come through, as well as what was going on across the lifespan, and in particular, with adults. This got GSK motivated to think about what resources they could put out into the public domain to partners around adult immunizations other than COVID-19.
Three were an estimated 37 million missed adolescent and adult vaccinations during the course of the pandemic. With the dashboard, GSK partnered with IQVIA to use claims data to look at trends in recommended adult vaccines. Currently, the Vaccine Track dashboard looks at data from 2020 and 2021 and uses 2019 as its pre-pandemic baseline (a high watermark for adult vaccination).
This tool is providing a directional view of where we are in terms of claims data. This data can provide trends, but it does not provide a true vaccine coverage rate.
Chip Schaible (IQVIA),
Currently, Vaccine Track is used to show the decline in vaccination during the COVID-19 years. There is a menu at the top of the homepage. One of the choices is “Vaccines,” which will take the user to the list of vaccines that the user can analyze, with links to CDC for more information on each vaccine. The “Contact” section is important in that it is a way to ask a question about the website, and these questions help fill in the gaps in the FAQ section at the bottom of the website.
There are over 100K different sorts the user can do with the tool. The dashboard is very comprehensive and it’s very simple to use. The user can break down your sorts into vaccine type, age, gender, ethnicity, time, pay, etc., and discover new graphs each time. All adult vaccines are listed except for flu, as it’s a seasonal vaccine and skews the data. Down the right-hand side, there is the U.S. gap analysis, and when clicking each map, it will take the user to further details.
Trends will be updated on a quarterly basis. Currently, the dashboard is looking at 2021 data, but the data will be updated in October. Updates will continue on a quarterly basis.
Brad Burdette (IQVIA),
All of the claims data is nationally projected, however, both medical and pharmacy data is separate. The pharmacy data coverage is a little over 90%, however, the medical coverage data is much lower. The pharmacy data is enough to cover at the state level as well as the national level, however, there could be some sample bias.
Kate Hashey
This is one data set. The aim is to provide additional data for the public domain and have it updated regularly. The data in the fall will display the first half of 2022. The goal is for people to be able to quickly get a view of what’s happening on the national and state level, but also to look further to see who is getting vaccinated and where. This may help in not only seeing what was lost in the pandemic but also to also help find which areas of the country need to be focused on reaching the Healthy People goals set out by the HHS. Hopefully, there will be changes in the trends once Medicaid and Medicare legislation takes effect.
Questions
Q: In the future will there be any chance flu will be broken out by season vs calendar year? And will you be adding the COVID-19 vaccine?
Brad Burdette: We have the data by month, so feasibility wise we can aggregate it basically any way necessary. We would have to touch base with Chip and his team on how COVID-19 vaccine would be brought in with the other vaccines. We do have projected COVID-19 data. When we were talking about what to include there was so much COVID-19 information out there already that we didn’t want to include that in the tool initially.
Kate Hashey: We are trying to target our efforts to where we see the most need. There’s a lot of pediatric data out there and the same with COVID-19 data, so that’s why we focused on adults.
Q: Coming from a county coalition, it would be awesome if you could break down the data to the county level. Is there a way you can download the charts/maps into a PowerPoint slide? Would be great information to include in a presentation?
Kate Hashey: For the second part, in terms of printouts, we have thought about how to make it user-friendly for people. If you want to look at a certain state by certain demographics you could download it into a template. This is something we are thinking about. The other thing that came up in conversation are trainings to explore the data and make it as user friendly for people as possible.
Brad Burdette: We can report claims at that level of clarity down to the county. You could see some wild swings in sample sizes the lower you get. Yes, we can get the data to that level, it’s just should we given the data limitations.
Chip Schiable: If we drill down to lower levels, we can get to the county level but we cut off the number of visits in specific counties so it could drive a lot of “not applicable” in regard to the data due to the small sample size.
Q: How does this data differ from immunization registry data? Has it been compared?
Kate Hashey: Immunization registry data for adults is probably not as up to date, except for some states where there is more real-time data collection and greater reporting of adult vaccine data. We may have some crossover, but I do think that we may be adding to this to get a better picture of what is happening in the state.
Chip Schiable: We have not compared this data to the registry. We can take this as a follow-up and investigate it.
Q: As this population is adults 19+, is it assumed the percentage of the population that gets vaccinated at alternative locations like workforces/schools, vaccine drives, or hospitals is accounted for or negligible?
Brad Burdette: Hospitals and school sites are not accounted for in the data. It focuses more on office claims, medical claims, and retail pharmacy claims. I can’t speak to whether it’s a negligible volume or not. It is one of the gaps unfortunately that we have using claims data.
Q: The descriptions of the data used in Vaccine Track show that the Medicaid data only includes FFS claims and Medicaid managed care claims are included in the Commercial group. Is this true? If yes, can you separate these 2 groups?
Brad Burdette: We need a team that maps the payer information to a payer type. Currently, when you look at the map that we are using, the only Medicaid is specifically “Medicaid fee for service.” We should be able to break off a chunk of other Medicaid types but there would still be limitations as to what’s on the claims.
Kate Hashey: Also breaking out the Medicare part B for service would be another good source. Immunization data is fragmented and very complex. We welcome any feedback, and we are looking into some of these things actively to improve the tool.
Q: Do you think differences that you see between men and women, men getting flu shot earlier in states such as Vermont and RI, are real?
Kate Hashey: The trend is there but the absolute number could be different depending on what data the state is capturing. There is a full FAQ page that I encourage people to check out and reach out to us with any questions.
Announcements
- The 2022 National Adult and Influenza Immunization Summit (NAIIS) will be held on November 2–3, 2022 at the Crowne Plaza Atlanta Perimeter at Ravinia in Atlanta, Georgia. While registration is free, once the meeting registration hits max capacity, registration will be closed. For more information and to register visit izsummitpartners.org/2022-naiis-adult.
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