Medicare Coverage For Shingles Vaccine
Shingrix is not the first shingles vaccine, but it is the only one currently on the market in the United States.Instead of using a live virus,the vaccine uses a protein from the virus to trigger an immune response. It is administered in two doses two to six months apart.
This shingles vaccine has been shown to decrease the risk for shingles by 97% for people between 50 and 69 years old and by 91% for people 70 and older. It reduces complications as well. The risk for post-herpetic neuralgia goes down by 91% and 89%, respectively, in those age groups.
Because the vaccine works well, it is important to know if and when Medicare covers it.
Shingrix Is Recommended For All Adults Over 50
by Garrett Schaffel, AARP, March 20, 2018
Andrii Zastrozhnov/Getty Images
A new shingles vaccine is now available in pharmacies and from physicians.
The new shingles vaccine recommended by the Centers for Disease Control and Prevention for people 50 and older is now widely available in pharmacies and with physicians.
Testing found that Shingrix, which received Food and Drug Administration approval last fall, was 97 percent effective in adults 50 to 69 and 91 percent effective in those 70 and older. Those are far better results than provided by the previous vaccine, Zostavax, which was recommended for people 60 and up.
CVS announced this week that Shingrix is available in its stores nationwide, making it the latest of major chain pharmacies including Walgreens, Duane Reed, Walmart and Albertsons to have it. It has been available to doctors since late November, but patients should check with their own physicians to determine whether they can get the shots there.
Shingrix is taken in two doses separated by two to six months. Zostavax, the previously recommended vaccine, was a one-shot dose. The CDC says even those who have received a Zostavax shot should get the new drug, as should those who have had shingles.
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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How Can You Save On The Cost Of The Shingles Vaccine
These five tips can help you pay less for a shingles vaccine.
How Safe Is Shingrix
studies showed that Shingrix was safe and effective.
There have been concerns about ingredients, such as thimerosal, that may be added to vaccines. Thimerosal is a kind of preservative that contains mercury. Its added then taken out of some vaccines to keep other germs and bacteria from growing. The concern arose when early research connected thimerosal to autism. This link has since been found to be false. Shingrix doesnt contain thimerosal.
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Does Medicare Cover Shingrix And How Much Does It Cost
Shingrix is covered by Medicare. Your copay, however, will depend on your Medicare plan. Unfortunately, Shingrix can still cost almost $200 with Medicare. Your pharmacist can help you calculate the exact Shingrix price with your particular plan.
If your out-of-pocket expenses with Medicare are still too high, consider using SingleCare to save more on Shingrix. Registration is free and we’ll send you a savings card in the mail that you can use on all of your prescription drugs.
In the meantime, take one of our Shingrix coupons to any of the participating pharmacies, such as CVS Pharmacy, Walmart, or Walgreens, to find out how much you can save on your Shingrix cost today.
Im Living With Hiv Is It Safe For Me To Get Shingrix
The Centers for Disease Control and Prevention hasnt made a recommendation about the use of Shingrix in people living with HIV.
However, one study looked at healthy adults ages 18 and older who were living with HIV and had an HIV dosing schedule that was customized to their needs. These people received the Shingrix vaccine, and the study results did not report any safety issues.
If youre living with HIV, talk with your doctor about the risks and benefits of getting Shingrix.
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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.
Can I Get Shingrix If Ive Never Had Chickenpox
If youve never had chickenpox , the CDC recommends that you get the chickenpox vaccine instead of Shingrix. Researchers havent studied Shingrix in people who have never had chickenpox. And Shingrix is not approved for preventing chickenpox.
If you cant recall whether youve had chickenpox, you may need to be screened for it. But this will depend on your age.
Its assumed that people born in the United States and elsewhere before 1980 have been exposed to chickenpox. Therefore, you may be able to receive Shingrix. You should check with your doctor first to make sure.
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How To Save On Shingrix
If you need to lower your out-of-pocket cost for Shingrix, consider coupons, manufacturer rebates, and patient assistance programs. You can use a SingleCare discount card, which can help you save up to 80% off drug prices, or one of our coupons for Shingrix to pay $187.91 for 1, 50MCG/0.5ML Suspension Reconstituted.
There isn’t a Shingrix manufacturer coupon currently available, but eligible patients can still benefit from a Shingrix patient assistance program provided by the GSK Patient Assistance Program. Check with this program’s provider to find out whether you’re eligible for these benefits.
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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Can Shingrix Cause A Rash
Its unlikely that a Shingrix injection will cause a rash. But note that an injection site reaction is different from a shingles rash.
A shingles rash, which is caused by shingles itself, is often painful. It commonly appears as blisters around the torso, neck, or face.
People who received Shingrix in didnt report shingles-like rashes.
However,
The Food and Drug Administration approves vaccines such as Shingrix to prevent certain conditions.
What Are My Options For The Shingles Shot And How Does It Work
As of November, 2020, there is only one shingles vaccine available in the United States. This goes by the trade name Shingrix.
Shingrix was approved by the FDA in . It is more than 90 percent effective at preventing shingles and postherpetic neuralgia after two doses of the vaccine.
An earlier vaccine, Zostavax, is no longer in use in the United States as of November 18, 2020. Zostavax first got FDA approval in 2006. It was about 51 percent effective at preventing shingles and 67 percent effective at preventing PHN.
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How Should You Treat Shingles
Antiviral medicines like acyclovir, valacyclovir, and famciclovir have been developed to reduce the length and severity of the illness. They are most effective when started soon after the shingles rash appears. Consequently, you should call your health care provider to explore treatment options as soon as you contract or believe you have contracted shingles.
Topical or oral pain medicines may help reduce the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths may also help relieve itching.
More Common Side Effects
The more common side effects of Shingrix can include:
- pain, redness, and swelling at site of injection*
- dizziness or fainting
- flu-like symptoms, including fever, shivering, and tiredness
Most of these side effects may go away within a few days or a couple of weeks. If theyre more severe or dont go away, talk to your doctor or pharmacist.
* For more information about this side effect, see Side effect details below.
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Where And How To Get Vaccinated For Shingles
Medicare requires all Part D plans to cover the shingles vaccine. However, since Part D plans have networks, youll want to be sure you get the vaccine at a pharmacy in the plans network.
Do not get the shingles vaccine at your doctors office. Doctors offices dont have the ability to bill Part D plans. Therefore, getting the vaccine at your doctors office could result in you paying the entire bill and having to submit a reimbursement request to your plan.
What Are The Side Effects Of Shingrix
Common side effects associated with Shingrix use include headache, muscle pain, tiredness, abdominal pain, nausea, vomiting, and diarrhea. Other side effects include fever, shivering, and redness, pain, and swelling at the injection site. You should seek immediate medical attention if you experience serious side effects. Contact your healthcare provider for more information, as this is not a complete list of possible side effects. It is recommended that you seek medical advice before using Shingrix. You should also let your doctor know if you may be allergic to any of the active or inactive ingredients in Shingrix.
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What Should You Do If You Have Shingles
These simple steps can help you reduce the severity and spread of shingles:
- Cover the rash at all times
- Do not touch or scratch the rash
- Wash hands often to prevent the spread of the virus
- Before the rash develops crusts, avoid contact with:
- pregnant women who have never had chickenpox or been vaccinated against it
- premature or low birth-weight infants
- people with weakened immune systems including those receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with HIV.
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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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 Prevent Shingles
Vaccination is the ONLY way to reduce the risk of getting shingles. The CDC recommends that people aged 50 years and older get two doses of the Shingrix® shingles vaccine.
If you have questions about your shingles vaccination, you should talk with your Rite Aid Pharmacist or other health care professional.
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Cdc Recommendation For The Shingles Vaccine
The Centers for Disease Control and Prevention recommend Shingrix as the preferred vaccine to prevent shingles and other complications from the disease.
The CDC found that Shingrix was more effective than Zostavax. It recommends that you receive Shingrix, even if youve had Zostavax in the past.
The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.
Dosage For Shingles Prevention
Shingrix is given as two 0.5-mL injections in your upper arm. Youll receive two doses of this vaccine.
Over time, some vaccines protection begins to fade, so may you need booster doses. They help keep the vaccine working. But you dont need a booster dose after getting the two doses of Shingrix.
Shingrix dosing schedule for people ages 50 years and older
For people ages 50 years and older taking Shingrix, the second dose is given 2 to 6 months after the first dose.
Shingrix dosing schedule for people ages 18 years and older with an increased risk of shingles
For people ages 18 years and older with an increased risk of shingles who are taking Shingrix, the second dose may be given 1 to 2 months after the first dose.
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Is The Shingles Shot Covered By Medicare
Original Medicare does not pay for the shingles vaccine. However, if youre enrolled in a Medicare prescription drug plan or have a Medicare Advantage plan that includes drug coverage, your shot may be covered. For vaccines covered under Part D , it is not recommended to get the shot through your providers office, as you may have issues with Part D billing.*
What Routine Vaccines Are Covered By The Affordable Care Act
If you have insurance, you may not have to pay anything for certain vaccines. Many preventive care services are provided through health insurance plans at no out-of-pocket cost to you as part of the Affordable Care Act . This means you can receive certain services without a copay or coinsurance even if you have not met your deductible. Preventive care includes wellness visits, screenings, and routine vaccines.
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