Why Medicare Does Not Cover Pneumococcal Vaccine

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Why Medicare Does Not Cover Pneumococcal Vaccine

December 07
16:23 2017

For the past couple of years, numerous television commercials have strongly pushed everyone 65-years of age and older to get a pneumococcal vaccine. One commercial depicts an older woman who says she suddenly got sick and her doctor told her if she hadn’t gotten help when she did that she would probably have died in just a couple of days. Then she says her near-death illness could have been avoided had she gotten a pneumococcal vaccine. They make it sound that everyone who doesn’t get the vaccine stands a good chance of dying as a result.

Since I have a weakened immune system due to living in constant pain and sleep problems, I decided to look into getting the pneumococcal vaccine. The only health insurance I have is Medicare Parts A & B. I wish I could afford more coverage, but I feel paying the mortgage and feeding my wife and I are more important.

When I called to find out if Medicare covered the pneumococcal vaccine, I was surprised to find out that it didn’t, but it did cover the hepatis C vaccine. Since I had hepatis A in 1980, it was recommended I get that vaccine especially since it was covered under Medicare. I tried to question why the one vaccine is covered but the other wasn’t and no one could give me a clear explanation as to why the difference, only that this was policy.

A new report may provide the reason, or one of the reasons, the Medicare does not cover the pneumococcal vaccine and it has to do with the cost, which increases every year, even though the vaccine remains unchanged.

The vaccine is not just recommended for us older adults, but it’s also recommended for children under the age of 2 and some schools are requiring it along with other vaccines before allowing young students to attend.

The pneumococcal vaccine is known as Prevnar 13 and it’s only made by one company, Pfizer Inc., and that’s a problem.

According to Dr. Lindsay Irvin, a Texas pediatrician, every November she receives a letter from Pfizer saying the cost of Prevnar 13 is going up, again. She says that her cost for the vaccine goes up at least 5% to 6%. That may not sound like much of an increase, but since Prevnar 13 was released in 2010, the cost has gone up more than 50%.

Irvin said that Prevnar 13 is the most expensive vaccine she administers:

“They’re the only ones who make it. It’s like buying gas in a hurricane — or Coke in an airport. They charge what they want to.”

This causes one to wonder if this could be part of the underlying reason why Medicare Parts A & B don’t cover this vaccine when it does cover other vaccines?

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