• The COVID-19 pandemic created significant disruptions in routine preventative care, including for immunizations. While many adult vaccination rates were well below national targets in 2019, Vaccine Track uses 2019 as the baseline for adult vaccination numbers while also offering month-over-month and year-over-year comparisons to visualize changing trends in US adult vaccination claims for hepatitis A, hepatitis B, tetanus-diphtheria (Td), tetanus-diphtheria-pertussis (Tdap), shingles and pneumococcal disease.

• As future Vaccine Track analyses incorporate respiratory syncytial virus (RSV) vaccination data, the RSV baseline will be 2023, which is the year RSV vaccines became available to older adults.

Vaccine claims data are information from claims submitted when providers administer immunizations to patients. The vaccine claims data in this tool include data from both medical and pharmacy vaccine claims.

• A medical claim is a request for payment that an enrollee or health care provider submits to a health insurer when an item or service is provided that should be covered by your plan.

• A pharmacy claim represents paid items or services rendered.

No. True immunization coverage rates cannot be calculated with claims data due to lack of longitudinal follow up. Future iterations of Vaccine Track could project an estimated immunization coverage rate.

Vaccine Track assesses claims for Advisory Committee on Immunization Practices (ACIP)-recommended vaccines for adults aged ≥19 years. Currently, assessed vaccines include:

• ≥19 years: Hepatitis A, Hepatitis B, Td, Tdap

• ≥50 years: Shingles

• ≥65 years: Pneumococcal

Flu and RSV vaccines are included in Vaccine Track but are not yet included in data analyses. COVID-19 vaccines are currently excluded from Vaccine Track.

For the initial launch of Vaccine Track, the data focuses on adult vaccine claims. There are several reasons for this.

• First, adult immunization rates remain suboptimal and off national targets and the COVID-19 pandemic has had significant impact on adult vaccine uptake in the U.S. Vaccine Track aims to elucidate trends in adult vaccine claims data that have historically lagged in terms of up-to-date reporting.

• Additionally, there are limitations with both the availability and variability of data on vaccines provided through the Vaccines for Children (“VFC”) Program, which may not fully capture the population.

• No. Vaccine Track visualizes raw and projected vaccine claims data and reports total administrations. Future iterations of Vaccine Track could assess series completion for multidose vaccinations.

• Cash (or Self-Pay): Direct patient payment for services (possibly due to lack of insurance coverage or opting to not use insurance coverage).

• Medicaid: Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. Some states have elected to expand Medicaid eligibility to low-income adults as defined under the Affordable Care Act (ACA) — Medicaid expansion adults. Under provisions included in both the ACA’s Medicaid expansion and the Inflation Reduction Act (IRA), all adults with Medicaid coverage are eligible for ACIP-recommended vaccines without cost-sharing. Prior to these policy changes, coverage and cost sharing for recommended vaccines for the non-Medicaid expansion adult population varied as states could elect whether to cover these vaccines or require cost-sharing. States also have two approaches to delivering and paying for health care services in Medicaid:
  States also have two approaches to delivering and paying for health care services in Medicaid:

  • Medicaid Fee-for-Service (“FFS”). States may pay for some or all Medicaid benefits directly on behalf of beneficiaries, which is known as Medicaid FFS.

  • Medicaid Managed Care. Some states may choose to contract with managed care organizations (MCOs) to provide Medicaid coverage to some or all Medicaid beneficiaries. Some of these states may also “carve out” certain benefits, like drug coverage, from managed care, to be covered under Medicaid FFS.

• Commercial: Private insurance coverage that includes employer and other group health plans, small group and individual coverage (both on and off Health Insurance Exchanges). Private commercial plans cover all ACIP-recommended vaccines without cost-sharing.

• Medicare: Medicare provides health insurance for people aged ≥65 years, for persons under age 65 with certain disabilities and for individuals of any age with end-stage renal disease. Coverage for vaccines in Medicare is split between vaccines covered under Medicare Part B and vaccines covered under Medicare Part D. Medicare beneficiaries may receive coverage through fee-for-service Medicare or through Medicare Advantage plans, which are private plans offering the Medicare benefit. In future versions of the tool, these populations may be analyzed separately.

  • Medicare Part B: Medicare Part B covers influenza, pneumococcal, hepatitis B for high-risk populations, and COVID-19 without cost-sharing.

    • Previously, hepatitis B vaccination was only covered for beneficiaries determined to be at intermediate-to-high risk for infection. The Centers for Medicare & Medicaid Services (CMS) recently finalized a proposal to include people who have not previously received a completed hepatitis B vaccination series and people whose vaccination history is unknown in the intermediate risk category, effectively ensuring no-cost hepatitis B vaccination coverage for all Medicare Part B beneficiaries who need it.

  • Medicare Part D: Medicare Part D provides voluntary drug coverage to those aged ≥65 years, under age 65 with certain disabilities or individuals of any age with end-stage renal disease. Medicare Part D covers all other ACIP-recommended vaccines that are not covered by Medicare Part B. The IRA eliminated cost-sharing requirements for ACIP-recommended Part D vaccines effective January 1, 2023.

• While this data presents Medicaid FFS claims, there are limitations to the data captured even for Medicaid FFS population. The Medicaid FFS data does not include immunization data for Medicaid FFS beneficiaries that received immunizations at public health departments, Federally Qualified Health Centers (FQHCs) or through some state vaccine purchasing programs.

• Yes. Previously, Medicaid managed care data was included in the commercial data as third-party payer data. In a recent enhancement, more granular plan information was leveraged to identify and break out Medicaid managed care claims from the commercial rollup.