Sec. 11401. Coverage of adult vaccines recommended by the Advisory Committee on Immunization Practices under Medicare part D

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Section 1860D–2 of the Social Security Act ( 42 U.S.C. 1395w–102 ), as amended by sections 11201 and 11202, is amended— in subsection (b)— in paragraph (1)(A), by striking The coverage and inserting Subject to paragraph (8), the coverage ; in paragraph (2)— in subparagraph (A), by inserting and paragraph

(8)after and

(E); in subparagraph (C)(i), in the matter preceding subclause (I), by striking paragraph

(4)and inserting paragraphs

(4)and

(8); and in subparagraph (D)(i), in the matter preceding subclause (I), by striking paragraph

(4)and inserting paragraphs

(4)and

(8); in paragraph (3)(A), in the matter preceding clause (i), by striking and

(4)and inserting (4), and

(8); in paragraph (4)(A)(i), by striking The coverage and inserting Subject to paragraph (8), the coverage ; and by adding at the end the following new paragraph: For plan years beginning on or after January 1, 2023, with respect to an adult vaccine recommended by the Advisory Committee on Immunization Practices (as defined in subparagraph (B))— the deductible under paragraph

(1)shall not apply; and there shall be no coinsurance or other cost-sharing under this part with respect to such vaccine. For purposes of this paragraph, the term adult vaccine recommended by the Advisory Committee on Immunization Practices means a covered part D drug that is a vaccine licensed under section 351 of the Public Health Service Act for use by adult populations and administered in accordance with recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. ; and in subsection (c), by adding at the end the following new paragraph: The coverage is in accordance with subsection (b)(8). . Section 1860D–14(a) of the Social Security Act ( 42 U.S.C. 1395w–114(a) ), as amended by section 11201, is amended— in paragraph (1)(D), in each of clauses

(ii)and (iii), by striking In the case and inserting Subject to paragraph (6), in the case ; in paragraph (2)— in subparagraph (B), by striking A reduction and inserting Subject to section 1860D–2(b)(8), a reduction ; in subparagraph (D), by striking The substitution and inserting Subject to paragraph (6), the substitution ; and in subparagraph (E), by striking subsection

(c)and inserting paragraph

(6)of this subsection and subsection

(c); and by adding at the end the following new paragraph: For plan years beginning on or after January 1, 2023, with respect to an adult vaccine recommended by the Advisory Committee on Immunization Practices (as defined in section 1860D–2(b)(8)(B))— the deductible under section 1860D–2(b)(1) shall not apply; and there shall be no cost-sharing under this section with respect to such vaccine. . Section 1860D–15 of the Social Security Act ( 42 U.S.C. 1395w–115 ) is amended by adding at the end the following new subsection: In addition to amounts otherwise payable under this section to a PDP sponsor of a prescription drug plan or an MA organization offering an MA–PD plan, for plan year 2023, the Secretary shall provide the PDP sponsor or MA organization offering the plan subsidies in an amount equal to the aggregate reduction in cost-sharing and deductible by reason of the application of section 1860D–2(b)(8) for individuals under the plan during the year. The Secretary shall provide a subsidy under paragraph (1), as applicable, not later than 18 months following the end of the applicable plan year. . Section 1860D–2(b)(4)(C)(iii)(I) of the Social Security Act ( 42 U.S.C. 1395w–102(b)(4)(C)(iii)(I) ), as amended by section 11201(a)(3)(C), is amended— in item (cc), by striking or at the end; and by adding at the end the following new item: under section 1860D–15(h); or . Nothing in this section shall be construed as limiting coverage under part D of title XVIII of the Social Security Act for vaccines that are not recommended by the Advisory Committee on Immunization Practices. The Secretary shall implement this section, including the amendments made by this section, for 2023, 2024, and 2025, by program instruction or other forms of program guidance.

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42 USC 1395w–102
42 USC 1395w–114(a)
42 USC 1395w–115
42 USC 1395w–102(b)(4)(C)(iii)(I)

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Sec. 11401

Coverage of adult vaccines recommended by the Advisory Committee on Immunization Practices under Medicare part D

Cite42 USC 1395w–102

Cite42 USC 1395w–114(a)

Cite42 USC 1395w–115

Cite42 USC 1395w–102(b)(4)(C)(iii)(I)

Cites 4Cited by 0 across 0 sources