Letter to Matt Eyles, CEO of America's Health Insurance Plans - Rep. Porter Calls on Health Insurers to Guarantee Coverage of COVID-19 Vaccine

Letter

Mr. Eyles,

We write to you today in hopes that we can work with you and your members, our country's
health insurance providers, to guarantee the affordability of vaccines for insured patients. As you
are aware, due to an incredible investment of resources and the diligent work of scientists across
the globe, we are fortunate to now have two COVID-19 vaccines authorized by the Food and
Drug Administration (FDA) for emergency use. It is critical that we deploy these vaccines
quickly and effectively to achieve widespread immunity. In order to do this, we need the
cooperation of your members. Specifically, we ask that your organization and its membership
adopt language that will make it clear that patients will not be responsible for any cost sharing
requirements for the administration of the vaccine.

We cannot risk patients receiving surprise bills for vaccine administration. Unfortunately, despite
Congress's best efforts to protect against surprise billing for testing and treatment for COVID19, there has been an endless trickle of stories of patients receiving devastating bills for these
services.1,2 This deters patients from pursuing the care they need, and inhibits the deployment of public health measures to gauge and prevent spread of the virus.

Were cost to become a factor in individual decisions to receive the vaccine, it could slow the spread of the vaccine rollout, placing lives at risk and exacerbating the burden on our health care system.

Insurers can easily put a stop to this possibility. This is why we are asking you to join us as a partner in the fight to end this pandemic.

Under 42 USC 300gg-13(a), which governs insurance coverage of preventive health services, "A
group health plan and a health insurance issuer offering group or individual health insurance
coverage shall, at a minimum provide coverage for and shall not impose any cost sharing
requirements for . . . (2) immunizations that have in effect a recommendation from the Advisory
Committee on Immunization Practices of the Centers for Disease Control and Prevention with
respect to the individual involved." Rulemaking further clarifies these requirements,6
and late last year, the Centers for Medicare and Medicaid Services provided additional guidance
expanding on coverage requirements established under Section 3713 of the Coronavirus Aid,
Relief, and Economic Security Act(CARES) Act.7 However, despite these efforts, we remain
concerned that some insurers may circumvent these requirements, as we've seen repeatedly with
testing and treatment costs. We ask that the following proposed language be adopted by all
health plans and sponsors to verify that insurers treat the vaccine as falling within preventive
health services provisions, and do not skirt coverage requirements because of the location or
timing of the vaccination. As such, we propose the following language to provide additional
clarity for American consumers:

"To ensure that as many Americans as possible will be able to receive the COVID-19
vaccine expeditiously and at no cost to them, the COVID-19 vaccine will be deemed to
be a preventive health service that falls within 42 USC 300gg-13 and its implementing
regulation, 29 CFR 2590.715-2713, such that the vaccine will be provided to insureds
without any cost-sharing requirements, such as a copayment, coinsurance, or a
deductible. Further, insurers and plan sponsors agree to cover any such vaccine under this
provision at any convenient location where such vaccine is available to the public,
whether offered by a physician, nurse, or other health care professional, in a physician's
office, a health care center, a pharmacy or otherwise and agree to do so even after the
Public Health Emergency has ended and even for those vaccine doses not purchased by
the federal government."

We thank you in advance for working with us to protect the American people and end this
pandemic. If, for any reason, you or your members refuse to adopt these provisions we ask them
to provide a detailed explanation as to why they will not include this under their coverage of the
vaccine for their beneficiaries. Because of the urgency of this request, we request that you
respond by January 25, 2020.

Source