Richard H. Hughes, IV, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in Forbes, in “RSV Vaccines Aren’t Covered by Medicare for These Vulnerable Groups,” by Arianna Johnson.

Following is an excerpt:

Some seniors and pregnant people—among the most vulnerable to respiratory syncytial virus (RSV)—are forced to pay out of pocket (upwards of $300) for an RSV vaccine this year due to a loophole that means it’s not covered under all Medicare plans.

Seniors and infants are the most vulnerable groups facing the respiratory syncytial virus (RSV), and there are two Food and Drug Administration approved vaccines designed to protect seniors against RSV and one for infants through their pregnant parents.

The RSV vaccines (like shingles and hepatitis A vaccines) are covered under Medicare Part D, which covers vaccines as prescription drugs, but may require a vaccine administration fee.

But around 16 million Medicare beneficiaries aren’t enrolled in Part D, according to data from health policy research organization KFF, so they have to pay for the RSV vaccine out-of-pocket, leaving some patients with a $330 bill, the New York Times reports. …


“This is just the result of poor policy making,” Richard Hughes IV, a vaccine-law expert at the firm Epstein Becker Green and the former vice president of public policy at Moderna told the New York Times. “I think that vaccines, all vaccines, should be accessible in all settings of care, and so this fragmentation is really just not good.”

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