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Anthem Blue Cross Shingles Vaccine Coverage

There Are At Least Two Vaccines That All Adults Should Get

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  • All adults need a seasonal flu vaccine every year. Flu vaccine is especially important for people with chronic health conditions, pregnant women, and older adults.
  • Every adult should get a Tdap vaccine if they didnt receive it when they were younger to protect against pertussis , and then a Td or Tdap booster shot every 10 years. Women should get the Tdap vaccine each time they are pregnant, preferably between 27 and 36 weeks.

How Can I Get A Shingles Vaccine

While most people get their shingles shots at a pharmacy, some receive it at their doctors office. At one time, some states required a prescription to get the shingles vaccine at a pharmacy, but those states have recently changed their rules. Now you dont need a prescription to get the shingles vaccine.

At a pharmacy. Pharmacists in all states can administer vaccines included on the CDC-recommended adult immunization schedule, including the shingles vaccine. Make sure your pharmacy is in your Part D plans network so it can bill your plan directly. Check with your pharmacy and insurance plan for details.

At a doctors office. Its a good idea to confirm your doctor can bill Medicare Part D before you plan to get the vaccine there. Otherwise, you may need to pay for the vaccine and submit a claim for reimbursement to your Part D plan. Ask the doctors office and your plan about the rules.

Keep in mind

If you have trouble affording Part D prescription drug coverage, you may qualify for the Extra Help program, a government program that helps people with limited income and assets pay premiums and out-of-pocket costs for Part D drug coverage. Starting in 2024, the Inflation Reduction Act also expands the level of income eligibility for the Extra Help program.

Update October 11, 2022

What Are The Benefits Of The Shingles Vaccine

The shingles vaccines are the best way to protect you from getting shingles. The vaccines have been shown to reduce the risk of getting shingles by 50% for Zostavax® II, and to more than 90% for Shingrix®.

For those who still get shingles after being immunized, the vaccines can reduce pain, including the type of pain that lasts after shingles.

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New Members Can Get Vaccines At Pharmacies

Effective immediately, members 18 years of age and older with pharmacy benefits can now go to a participating Express Scripts retail pharmacy to receive 11 different immunizations. Vaccines are covered with no cost share to the member and a prescription is not required. Previously, only the flu vaccine was available from a retail pharmacy.

The 11 vaccines are:

In Massachusetts, the pharmacist must be registered and licensed to administer the vaccine. Since requirements vary in other states, members should contact their local pharmacy to confirm availability.

Your employees can continue to get their immunizations at their doctor’s office or at an outpatient clinic. The addition of the pharmacy option is intended to expand access to these preventive services. Employees should contact their pharmacy directly to confirm if a pharmacist is available to administer any of these vaccines.

This benefit applies to all Access Blue, HMO, PPO, POS, and indemnity plans with pharmacy benefits.

How Much Do Vaccines And Shots Cost With Insurance

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Without health insurance, shots and vaccines are paid out-of-pocket. This means something like the shingles vaccine could cost you around $200 if you are uninsured.

With insurance, many preventive shots are covered, although you are still responsible for any copay or deductible your health plan has. The cost of vaccines and shots depends on two factors: the type of shot or vaccine, and your insurance coverage.

For Blue Cross Blue Shield plans offered by CareFirst, vaccinations are completely free. You will pay no out-of-pocket copayment or coinsurance, and you will not have to pay toward your deductible.

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Is There A Downside To The Shingles Vaccine

Though the vaccine is deemed safe by the U.S. Food and Drug Administration , there are certain conditions in which the vaccine may not be safe for you.

  • The shingles vaccine has only been tested in adults over age 50 years and immunocompromised adults above 18 years thus, there is no recommendation for the vaccine for younger ages by the FDA.
  • You should not get the vaccine if you have had a severe allergic reaction to a previous Shingrix dose.
  • You have tested negative for immunity to varicella-zoster virus .
  • You have an active shingles infection.

Medicare And The Shingles Vaccine: Are You Covered

The shingles vaccine is covered through Medicare Part D or Medicare Advantage as part of your prescription drug benefits. In 2022, your actual costs for the vaccine depend on the specifics of your plan.

Beginning Jan. 1, 2023, all vaccines will be free under Medicare Advantage or Part D including shingles. No matter your plan, you’ll pay no deductible, copay or other costs for a shingles vaccine.

In 2022, you could pay less than $50 per shingles shot with a Medicare Part D plan from Aetna or Wellcare. If you don’t have prescription drug coverage, the full price for two doses of the Shingrix vaccine is $324, and several cost-saving options can help you get Shingrix for less.

Find Cheap Medicare Plans in Your Area

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Why Should You Get Vaccines

In short, they can protect against vaccine-preventable adult diseases. Check out these statistics from the CDC:

  • Since 2010, flu-related hospitalizations in the United States have ranged from 140,000 to 710,000, and flu-related deaths have ranged from 12,000 to 56,000.
  • About 320,000 people get pneumococcal pneumonia every year, leading to over 150,000 hospitalizations and 5,000 deaths, mostly among the elderly.
  • About 880,000 people have chronic hepatitis B, which can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death.
  • HPV causes over 27,000 cancers in women and men each year. About 4,000 women die each year from cervical cancer.

How Much Does The Shingles Vaccine Cost With Medicare

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Most people who are enrolled in Medicare Part D pay less than $50 per dose for Shingrix, according to the vaccine’s manufacturer GlaxoSmithKline. However, your costs will vary based on the plan’s details and if you’ve already met your deductible amount by purchasing other prescription drugs.

For example, some seniors can get the shingles vaccine for free because it’s fully covered by their Medicare Part D or Medicare Advantage plan. Others may have to pay a portion of the cost, such as a $50 copay per shot, or pay full price if the deductible hasn’t been met.

If you don’t have a prescription drug plan or you haven’t met your plan’s deductible, the retail cost for the shingles vaccine is $162 per shot. For the two-dose sequence, the total cost is $324. If the full price of the shingles vaccine is out of your budget, there are several ways you can save money on the vaccine.

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Anthem Blue Cross Adds Shingles Vaccine To Pharmacy Coverage

Updated blog post on pricing for Zostavax: Shingles Vaccine Price Varies from Pharmacy and Health Plan, August, 2013

Anthem Blue Cross has added the brand-name vaccine Zostavax for the immunization against the shingles virus to its drug formulary in California. This wont lessen the cost of approximately $160 for the one-time injection for those members with a Generic only prescription drug benefit. Other plans may have a pharmacy deductible that must be met before Brand Name drugs become eligible for the reasonable copayment price.

You can review your Evidence of Coverage for your specific health plan to see how the prescription drug benefit works. There are some rebate programs and discounts on-line for Zovatax that might help reduce the price. Just be careful that you are not signing up for some prescription drug discount card that charges you a non-refundable application or monthly fee.

How Does Your Medicare Deductible Affect Your Vaccine Costs

The deductible amount of your Medicare plan affects how much you pay out of pocket before your insurer starts contributing to the cost of your prescription drugs. Depending on how many medications you take, the deductible could affect how much you spend on the vaccine.

Below, we’ll compare how much you’d pay for the shingles vaccine on two plans with different deductibles. In this situation, the person with the MedicareRx Walgreens plan pays less overall, even though they’re paying full price for the shingles vaccine.

Scenario: Shingrix is the only medication needed during the policy

AARP MedicareRx Walgreens
Cost of two doses of Shingrix vaccine $160 each, for a total of $320, because the deductible hasn’t been met $45 copay each, for a total of $90
Total annual cost of premiums and shingles vaccine $788 $1,122

In the example above, the AARP MedicareRx Walgreens prescription drug plan has a $455 deductible for Tier 3 drugs like the shingles vaccine. That means if you haven’t already met your deductible, you would pay full price for the vaccine, which would be $320 for two doses. The plan costs $38.60 per month for someone living in Charlotte, N.C. If the shingles vaccine is the only Tier 3, 4, or 5 drug needed during the policy year, your total annual spending would be $788.

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How Much Is A Shingles Shot Under Medicare Part D

The good news is that the cost of a shingles vaccine, which comes in two timed doses, is subject to change in 2023.

Starting in 2023, the Inflation Reduction Act will eliminate all out-of-pocket costs for vaccines that the CDCs Advisory Committee on Immunization Practices recommends for adults. That includes the shingles vaccine.

However, in 2022 you may be charged a copayment for the shingles vaccine. This varies from plan to plan. The average Part D copayment for vaccines was $47 in 2020, according to Avalere Health, a health care consulting firm.

If you havent yet met your plans annual Part D deductible, which can be up to $480 in 2022, you may have to pay more for the shot. Shingrix, a vaccine the Food and Drug Administration approved in 2017, runs around $212 per dose.

It replaced Zostavax in November 2020. But even if you received Zostavax before it was retired, the CDC recommends getting inoculated with Shingrix: two doses for adults 50 and older spaced two to six months apart.

About The Shingles Vaccine

The Centers for Disease Control and Prevention recommends that healthy adults over the age of 50 get the shingles vaccine because it’s the only way to protect against the disease and its associated side effects. The risk of getting shingles increases as you age or if you have a weakened immune system. Always consult your doctor to find out if the shingles vaccine is right for you.

The CDC-recommended vaccine, Shingrix, is a recombinant zoster vaccine that has two doses administered within six months of each other. It’s classified as a Tier 3 drug by most insurance companies, which means it’s a brand-name pharmaceutical with a higher copayment than a Tier 1 or 2 drug.

Use the Shingrix vaccine locator to find where the shingles vaccine is being offered, and check with your Medicare Part D or Medicare Advantage provider to see which locations give you the lowest price.

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Why Doesn’t Medicare Cover The Shingles Vaccine As Free For All Seniors

Many people think that a vaccine that’s recommended by the CDC for those over age 50 would be fully covered by Original Medicare. However, there are a few reasons why you may end up paying hundreds of dollars for the two-dose regimen.

  • Medicare coverage levels: Some Medicare drug plans have better cost-sharing benefits than others, and how much you pay for the shingles vaccine depends on the plan you choose.
  • Pharmaceutical classification: Medicare classifies the Shingrix vaccine as a part of its pharmaceutical coverage, meaning it would fall under Medicare Part D coverage rather than Part A or Part B. In contrast, most private health insurance, either through an employer or through the marketplace, classifies the shingles vaccine as a part of its free preventative coverage.
  • Type of pharmaceutical: Shingrix is a Tier 3 drug made by GlaxoSmithKline, and there isn’t a generic alternative. This could mean that your out-of-pocket costs are higher than for other medications.

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Does Medicare Cover The Shingles Vaccine

All Medicare prescription drug plans offer some level of coverage for the shingles vaccine. You will find this coverage under your Medicare Part D plan or a Medicare Advantage plan.

The amount you pay will vary based on your policy details and your deductible amount. For some enrollees, the shingles vaccine could be free, but others may pay full price if a deductible must be met before the cost-sharing benefits begin.

The shingles vaccine is not covered by Original Medicare . However, Medicare Part B may cover a doctor’s visit to get a prescription for the shingles vaccine.

Most Medigap plans, also called Medicare supplement plans, don’t cover the shingles vaccine because they don’t include prescription drug coverage.

Medicare plan
Wellcare $28-$47

Typical costs based on available plans in Charlotte, N.C. , Boston , and Los Angeles .

Find Cheap Medicare Plans in Your Area

Remember that coverage for the shingles vaccine is usually just one aspect of your prescription drug needs. And the best Medicare Part D plan for you is determined by its total performance, including how well its coverage matches your prescription needs.

How Can You Save On The Cost Of The Shingles Vaccine

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These five tips can help you pay less for a shingles vaccine.

  • Visit an in-network pharmacy with a prescription: If you have a prescription drug plan, you could pay less for your vaccine by having it administered at an in-network pharmacy. Getting the shot at a doctor’s office may lead to an additional doctor’s fee for administering the vaccine.
  • Sign up for Medicare Part D or improve your drug coverage: During open enrollment, you can select a prescription drug plan that covers Tier 3 drugs, including Shingrix. Remember to consider the total policy costs for all of your prescriptions. Also, if you receive a low-income subsidy, Medicare Part D plans could be available for free.
  • Get a discount coupon for the shingles vaccine: Pharmaceutical retailers and networks may offer vaccine discounts. Usually, you’ll present the coupon or the drug discount card at the pharmacy to get the savings.
  • Use a state pharmaceutical assistance program: A state program may be available to help you reduce the cost of prescription drugs including the shingles vaccine.
  • Get assistance from the vaccine maker: GlaxoSmithKline offers the GSK Patient Assistance Program for those who meet certain criteria. You may qualify if you earn less than $32,200 annually.
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    Five Vaccines Covered By Your Medicare Plan

    Healthy aging is about more than just regular exercise and good nutrition. You also need to protect your body from illnesses that can harm your immune system.

    As we get older, our bodies dont regenerate the way they did when we were younger, says Christa Winterhalter, PharmD, manager of Pharmacy Programs at Highmark. We cant fightoff infections as easily or as often, so we need to take preventive actions to remain healthy.

    The Centers for Disease Control and Prevention recommends specific vaccines for people 65 and older. These vaccines help prevent influenza , pneumonia, shingles, tetanus and, most recently, COVID-19. Getting vaccinated is quick, easy, and affordable. Just make sure the administering doctor or clinic is covered by your Medicare plan.

    Heres everything you need to know about these five Medicare-covered vaccines:

    What Is The Shingrix Vaccine

    Shingrix is the U.S. Food and Drug Administrationapproved vaccine aimed to prevent shingles infection in individuals older than 50 years and adults aged 18 years and older who are or who will be at increased risk of shingles due to a disease or therapy that can compromise the immunity.

    The Herpes Zoster virus is the same virus that causes chickenpox in children. The virus may remain dormant in the persons nerve roots and become active when the immunity wanes .

    The reactivated virus causes shingles or Herpes Zoster, a painful condition characterized by painful red blisters over the body, rash, and/or fever.

    • A particular complication of shingles is postherpetic neuralgia , which persists for months after the infection subsides.
    • It is characterized by extreme pain at the former site of rash and lesions.
    • This pain may or may not respond to strong medications hence, a vaccine against shingles is required.

    The Shingrix vaccine works by exposing the body to small doses of the inactive herpes virus. This stimulates the bodys immune system and helps the body to develop an immunity to herpes zoster or shingles.

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