Potential Recommendation Change for Pneumococcal Vaccine Could Impact Older Adults

June 14, 2019

Changes to vaccine recommendations for older adults may mean they have to pay for pneumococcal vaccine themselves.

The Advisory Committee on Immunization Practices (ACIP) may rethink its recommendations for older adults receiving the pneumococcal vaccine-and the possible change is worrying some patient advocates.

ACIP, a subcommittee of the CDC, voted in 2014 to recommend that Medicare cover the more advanced pneumococcal vaccine, PCV-13, along with continuing coverage of the PPSV23 pneumococcal polysaccharide vaccine.

But the committee may revisit that decision at a meeting later in June, according to Forbes, leaving some concerned about the potential impact on older adults if the committee opts not to recommend Medicare coverage of the PCV-13 vaccine.

“If the ACIP votes against Medicare coverage of the PCV-13 pneumonia vaccine, the next step could be a CMS ruling saying Medicare Part B would no longer cover it. Then, older adults would be given a choice - either pay for the vaccine out of pocket (as much as $200 per dose) or not to get it at all,” Bob Blancato, wrote in Forbes. Blancato is on the board of AARP.

Karyne Jones, president and CEO of the National Caucus and Center on Black Aging (NCBA) also voiced concerns in an opinion piece in The Hill saying that if ACIP no longer recommends the vaccine it could have significant consequences.

“Doctors and pharmacists may not be inclined to tell patients they need it; cases of pneumonia could rise and, after my first-hand experience last year, I know we can’t stand by and let more people risk getting sick from this devastating disease,” she wrote.

According to data from the CDC, currently, 63.6% of adults over the age of 65 have received at least one  pneumococcal vaccine.

The use of the PCV-13 vaccine, which advocates believe is superior, has also seen significant growth in the Medicare population since the ACIP made its recommendation in 2014. According to a recent study from Avalere, the share of Medicare beneficiaries receiving the PCV13 pneumococcal vaccine increased from 2% to 87% in the first three years after the ACIP made its recommendation.

Patient advocates now worry that making any changes to the ACIP recommendation could have negative consequences for older adults, who are vulnerable to developing life-threatening consequences from contracting pneumonia.

“We should be doing everything we can to continue to grow these numbers, not make it harder for people to access and afford vaccines,” Jones wrote.

Those who advocate against making any changes to the recommendations, say having higher pneumococcal vaccination rates has other advantages to the entire population as well.

“Not only has this reduced pneumococcal disease, but there are other intangible benefits such as the reduced spread of illness to at-risk people,” family physician Zane Cooke, MD, wrote in The Tennessean. “Finally, there is a significant amount of healthcare dollars saved with disease prevention such as this.”

Blancato, who is also past chair of the American Society on Aging, testified about the benefits of the PCV-13 vaccine to the ACIP in 2014. He plans to travel to the ACIP’s meeting again at the end of this month to continue to advocate for the advantages he believes have come from increased use of the vaccine.

“Advocates will take their best shot so access to the best shot for an older adult to avoid pneumonia won’t be taken away,” he wrote.