Medicare Part B Coverage for Third Pneumonia Vaccine

[ellentk]

I've had the Prevnar 13 and Pneumovax 23 vaccines and want to get Prevnar 20 under Part B, traditional medicare, because I haven't reached my Part D deductible.

But although Medicare Part B is covering Prevnar 20 (scroll down to News on this page: https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/...), this page states that Part B only covers two shots: https://www.medicare.gov/coverage/pneumococcal-shots

Now that Prevnar 20 is available, will Medicare be updating its two-shot limit for Part B coverage?

Thanks..

[GailL1]

There is a CDC recommendation and a protocol - go down this page until you see recommendations for your age group.    It depends on which ones you have already had -   

There are only 2 types of pneumococcal vaccines available in the United States:

• Pneumococcal conjugate vaccines (PCV13, PCV15, and PCV20)
• Pneumococcal polysaccharide vaccine (PPSV23)

Pneumococcal Vaccination: Who and When to Vaccinate | CDC

[ellentk]

Thanks, Gail. I had read the CDC  guidance but didn't post a link to it because my question is about Medicare Part B coverage.

Relevant to me in the guidance is: "The incremental public health benefits of providing PCV15 or PCV20 to adults who have received PCV13 only or both PCV13 and PPSV23 have not been evaluated" as I've had PCV13 and PPSV23. Of course, the CDC statement is about public not individual health benefits. But since Prevnar 20 protects against seven more strains than Prevnar13, It's only logical that I'd be better protected.

[GailL1]

I don't think you are understanding the CDC guidance in relation to Medicare coverage.

There are only 2 types of pneumococcal vaccines available in the United States:

• Pneumococcal conjugate vaccines (PCV13, PCV15, and PCV20)
• Pneumococcal polysaccharide vaccine (PPSV23)

The above are the two (types) that Medicare pays for under Part B.

Medicare Part B (Medical Insurance)  covers 2 different pneumococcal shots. Part B covers the first shot at any time and a different, second shot if it’s given at least one year after the first shot.

What Medicare pays for is dependent on what you have had to date.

  Sounds like you have gotten all of them if you have had Prevnar 13 & Pneumovax 23 - (see the last paragraph on the CDC page of which I have copied and pasted below.)

Per the CDC lines:  from the link I gave in my previous reply. 

https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html 

Adults 65 Years or Older

CDC recommends pneumococcal vaccination for all adults 65 years or older. The tables below provide detailed information.

For adults 65 years or older who have not previously received any pneumococcal vaccine, CDC recommends you:

• Give 1 dose of PCV15 or PCV20.

• • If PCV15 is used, this should be followed by a dose of PPSV23 at least one year later. The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak.

• • If PCV20 is used, a dose of PPSV23 is NOT indicated.

For adults 65 years or older who have only received PPSV23, CDC recommends you:

• May give 1 dose of PCV15 or PCV20.

• • The PCV15 or PCV20 dose should be administered at least one year after the most recent PPSV23 vaccination.
  • Regardless of if PCV15 or PCV20 is given, an additional dose of PPSV23 is not recommended since they already received it.

For adults 65 years or older who have only received PCV13, CDC recommends you:

• Give PPSV23 as previously recommended.* See Pneumococcal Vaccine Timing for Adultspdf icon for specific guidance. The incremental public health benefits of providing PCV15 or PCV20 to adults who have received PCV13 only or both PCV13 and PPSV23 have not been evaluated.

* For adults who have received PCV13 but have not completed their recommended pneumococcal vaccine series with PPSV23, one dose of PCV20 may be used if PPSV23 is not available. If PCV20 is used, their pneumococcal vaccinations are complete.

=================

[GailL1]

@ellentk 

Came back to add:

Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U...

New Pneumococcal Vaccine Recommendations

Adults aged ≥65 years. Adults aged ≥65 years who have not previously received PCV or whose previous vaccination history is unknown should receive 1 dose of PCV (either PCV20 or PCV15). When PCV15 is used, it should be followed by a dose of PPSV23 (Table 1).