S.Amdt. 4518

SA 4518, submitted by Mr. Lujan, aims to ensure that certain immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention are covered without cost sharing. It proposes to add these requirements to the bill S. 1383.

The amendment intends to change and add the following to the law:

• Private and Group Insurance: It requires group health plans and health insurance issuers (including individual coverage) to provide coverage without cost sharing for immunizations that had a recommendation from the ACIP as of January 1, 2025. This includes vaccines updated or changed after that date via an approved supplemental application to a biological product licensed under section 351. This applies across the Public Health Service Act, ERISA, and the Internal Revenue Code.

• Medicare: It amends the Social Security Act to ensure that if a recommendation for a vaccine is revoked on or after January 1, 2025, the most recent recommendation in effect prior to that revocation still applies.

• Medicaid: It requires coverage and administration of vaccines recommended as of January 1, 2025. It specifically adds medical assistance for these vaccines for pregnant individuals and limits the ability of States to exclude these adult vaccines from benchmark coverage.

• CHIP: It requires that child health assistance for targeted low-income children includes coverage and administration of vaccines that had an ACIP recommendation as of January 1, 2025.