A Nasty Persistent Condition
Dr. Navjot Jain, an internal medicine specialist at The Ohio State University Wexner Medical Center, says shingles is an offshoot of the chicken pox virus.
While many people have experienced chicken pox and therefore have the dormant virus, those who experienced chicken pox before they were 18-months old are considered to be at a higher risk .
Basically, shingles is the activation of the varicella zoster virus, which causes chicken pox, Jain told Healthline. Herpes zoster, which causes the vesicular rash associated with shingles, is a reactivation of the varicella zoster virus.
Even after the initial painful rash caused by shingles dies down, the aftereffects can be even worse.
The most common thing that we see after shingles is something called postherpetic neuralgia, which is nerve pain that can last for months, typically 90 days or more, and sometimes for several years, said Jain. Its excruciating pain at the site of where the patient would have previously had the shingles rash.
The agony of postherpetic neuralgia is often enough to convince patients to get vaccinated against shingles, says Jain.
Theres also the fact that a subtype of shingles, herpes zoster ophthalmicus, occurs in about 15 percent of shingles cases. In rare cases, says Jain, this can lead to vision loss.
Shingles Vaccine For Older Adults
Shingles is caused by the same virus as chickenpox. If you had chickenpox, the virus is still in your body. As you get older, the virus could become active again and cause shingles.
Shingles affects the nerves. Common symptoms include burning, shooting pain, tingling, and/or itching, as well as a rash with fluid-filled blisters. Even when the rash disappears, the pain can remain. This is called post-herpetic neuralgia, or PHN.
The shingles vaccine is safe, and it may keep you from getting shingles and PHN. Healthy adults age 50 and older should get vaccinated with the shingles vaccine, Shingrix, which is given in two doses.
You should get a shingles vaccine even if youve already had chickenpox or the chickenpox vaccine, or if you don’t remember whether you had chickenpox. You should also get the shingles vaccine if you’ve already had shingles or received Zostavax. However, you should not get a vaccine if you currently have shingles, are sick or have a fever, have a weakened immune system, or have had an allergic reaction to Shingrix. Check with a health care provider if you are not sure what to do.
You can get the shingles vaccine at a doctors office and at some pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan to find out if it is covered.
Does Medicare Cover The Shingles Vaccine
En español | Unlike some common vaccines, like those for the flu, hepatitis B and pneumonia, shingles shots are not covered under Medicare Part B, the component of original Medicare that includes doctor visits and outpatient services. Part A, which deals with hospital costs, doesnt cover shingles shots either.
Medicare coverage for Shingrix and Zostavax, the two commercially available shingles vaccines, is provided only if you are enrolled in a stand-alone Part D drug plan or a Medicare Advantage plan that includes Part D drug coverage.
Medicare requires Part D plans to cover the shingles vaccine, so if youre enrolled in Part D, you shouldnt have difficulty obtaining the shot. Most require a copayment, which can vary widely from plan to plan.
And if you havent yet met your plans deductible for the year, youll likely pay the full price. For Shingrix, the newer vaccine, that averages around $190, according to GoodRx, a website and app that tracks prescription prices.
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How Well Does Shingrix Work
Two doses of Shingrix provide strong protection against shingles and postherpetic neuralgia , the most common complication of shingles.
- In adults 50 to 69 years old with healthy immune systems, Shingrix was 97% effective in preventing shingles in adults 70 years and older, Shingrix was 91% effective.
- In adults 50 years and older, Shingrix was 91% effective in preventing PHN in adults 70 years and older, Shingrix was 89% effective.
- In adults with weakened immune systems, Shingrix was between 68% and 91% effective in preventing shingles, depending on their underlying immunocompromising condition.
In people 70 years and older who had healthy immune systems, Shingrix immunity remained high throughout 7 years following vaccination.
What Is The Brand Name Of The Shingles Vaccine
There are 2 shingles vaccines used in the UK:
- Zostavax, a live vaccine given as 1 dose
- Shingrix, a non-live vaccine given as 2 doses, 2 months apart
Most people will have the Zostavax vaccine. The Shingrix vaccine is recommended if Zostavax is not suitable for you, for example if you have a condition that affects your immune system.
You can read more about the shingles vaccines in the patient information leaflets:
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How Do I Get Coverage For The Shingles Vaccine
Medicare prescription drug plans and Medicare Advantage plans that provide prescription drug coverage generally cover all commercially-available vaccinations. These plans will cover the vaccination medication and the administration of the shot by your doctor or physician. Depending on your plan benefits, you may have to pay a copayment or coinsurance amount. Make sure to follow your planâs guidelines for this vaccination to be covered.
You will pay the least amount of money out of pocket if you are vaccinated at a pharmacy in your drug planâs network. If you have questions about which pharmacies are included in your planâs network, contact your Medicare prescription drug plan or Medicare Advantage prescription drug plan for more information. To find a Medicare Part D plan in your area, enter your zip code on this page.
Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.
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Who Should Get The Shingles Vaccine
The CDC recommends it for healthy adults over the age of 50, but the FDA has approved Shingrix for people 18 and older who are or who will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy. This includes those who have already had shingles, which you can have more than once. Vaccination lowers the chances of a second round of the painful rash and of a serious outbreak and complications, Kistler says.
Thatâs why Duncan Isley, who had shingles at 45, recently got vaccinated. The outbreak he had was âfairly mildâ compared with the stories heâs heard from others. But itâs something he doesnât want to repeat.
âI had the classic torso rash and back pain. It was a very painful experience to be sure, and I still have some lingering, minor nerve sensations from time to time,â says Isley, who is now 53 and lives in Durham, NC. âI tell my close friends they should get vaccinated.â
You should also get vaccinated with Shingrix if you got an older shingles vaccine called Zostavax, which was withdrawn from the market in 2020. Zostavaxâs protection wears off with time, says Kathleen Dooling, MD, MPH, a medical officer and shingles disease expert at the CDC.
In the first year after vaccination, Zostavax prevented shingles about 60% of the time. âThat decreases in subsequent years, so that after a number of years itâs not clear that the vaccine is providing any protection,â she says.
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When Should I See A Doctor Because Of The Side Effects I Experience From Shingrix
Shingrix causes a strong response in your immune system, so it may produce short-term side effects. These side effects can be uncomfortable, but they are expected and usually go away on their own in 2 or 3 days. You may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen. Contact your healthcare provider if the symptoms are not improving or if they are getting worse.
In clinical trials, Shingrix was not associated with serious adverse events. In fact, serious side effects from vaccines are extremely rare. For example, for every 1 million doses of a vaccine given, only one or two people might have a severe allergic reaction. Signs of an allergic reaction happen within minutes or hours after vaccination and include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness. If you experience these or any other life-threatening symptoms, see a doctor right away.
Does Medicare Pay For Shingles Vaccines
Some Medicare Part D prescription drug plans and Medicare Advantage plans that include drug coverage may cover the shingles vaccine.
Original Medicare Parts A and B pay for inpatient and outpatient services, respectively, and neither typically pays for shingles vaccines.
Part D drug plans and Medicare Advantage prescription drug plans are offered to eligible Medicare beneficiaries and are sold by private insurance companies. Plans can vary by a wide margin on what they cover and how much they pay for drug-related services, and only a plan representative can give a definitive answer to whether a specific plan pays for SHINGRIX.
Most Part D and MA-PD plans do help cover the singles vaccine, however. The costs a beneficiary may face such as coinsurance, deductibles and copays for the vaccine may vary from plan to plan.
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Where To Get Vaccinated
You have a choice on where to get vaccinated.
In your doctors office: You can get vaccinated in your doctors office. If the office is set up to bill Part D directly for your vaccination, you may only have to pay a copay at the time of your shingles shot. If not, you may have to pay all costs upfront and submit a claim to your Part D plan for reimbursement.
At your local pharmacy: You can go to your local pharmacy to get your shingles shot as long as they offer the vaccine and appropriately trained staff members administer it. The rules for pharmacy vaccination vary by state. You will likely need to pay for the vaccination upfront. Pharmacies are not legally required to dispense medications without payment.
Vaccine Effectiveness And Safety
The vaccine reduces your chance of getting the virus by more than 50%, depending on your age. Vaccine effectiveness is higher among seniors between 65 and 70 years old.
No vaccine is 100% effective. If you get vaccinated, you may still develop shingles. But the infection would likely be less severe and youd be better protected from complications.
The vaccine has been licenced by Health Canada, having met all requirements under the Food and Drugs Act.
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Can I Get Free Or Discounted Vaccines Through Drug Company Patient Assistance Programs
Vaccine manufacturers offer financial assistance for a wide variety of vaccines. You may qualify for low-cost or even free vaccines through the makers patient assistance program.
Heres a chart listing some of the leading vaccine makers, their patient assistance websites, and the names of the vaccines they make to help you check eligibility guidelines:
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You can also use the Medicine Assistance Tool online to find out which assistance programs you qualify for and how to contact them. This tool lets you search for public and private programs that can help pay for medications, including vaccines. Just enter the name of the vaccine and answer a few eligibility questions. Then the search engine will tell you which programs you may qualify for and how to reach them.
Free Shingles Vaccine Extended For Seniors
Australians aged 71-79 years will continue to access free shingles vaccine, with the government extending the program for another two years.
- 28 October 2021
- Shingles especially impacts older people and one in two people have had it.
- Australian Government free vaccination program has been extended for another two years.
- 1.2 million people aged 71-79 have received the free vaccination.
Shingles is a serious disease usually affecting older people and can cause severe nerve pain that can last for months. The older you are when you get shingles, the greater your risk of developing more severe and long-lasting pain.
150,000 cases of shingles occur in Australia each year and by 85 years of age, one in two Australians will have had it.
The cost to the national health budget is nearly $17 million dollars with 3,600 hospitalisations and 105,000 GP consultations.
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What Vaccines Does Medicare Part D Cover
Medicare Part D is prescription drug coverage for Medicare beneficiaries. Medicare Part D coverage is offered through private insurance companies through either a stand-alone Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage.
According to the Department of Health and Human Services, Medicare Part D plans cover all vaccines that are:
- Commercially available
- Reasonable and necessary to prevent illness
- Not covered by Medicare Part B
While Medicare Part B generally covers most vaccines that Medicare patients need, Medicare Part D generally covers vaccines that Medicare Part B does not cover. This would include the shingles vaccine. All Medicare Part D plans are required to cover the shingles vaccine and its administration.
To see if travel vaccines are covered by your Medicare Part D plan, check with the planâs formulary, or list of covered drugs. A new preventative vaccine may not specifically appear in the Medicare Part D plan formulary but the plan may still cover the vaccine.
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Does Medicare Pay For Shingles Shots
Heres the quick answer
Surprisingly, Original Medicare doesnt cover the shingles vaccine, even though it covers other vaccines like the flu vaccine and pneumonia shot.
On the other hand, Medicare Part Dor a Medicare Advantage plan that includes Part D coveragetypically does cover the vaccine.
The devil is in the details
Every Part D plan is different, so your copay for a shingles vaccine could vary from one insurance plan to another. For this reason, its always good to check your plans formulary to see which vaccines they cover and which tier those medications fall under.
Part D covers a lot more than the shingles vaccine, providing coverage for prescription medications. If you need the shingles vaccine and prescription drug coverage, see our guide on how to find the best Part D plan for you, or learn more about Part D first.
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What Are The Possible Side Effects Of Shingles Immunisation
All medicines and vaccines can have side effects. Sometimes they are serious, most of the time theyre not.
For most people, the chance of having a serious side effect from a vaccine is much lower than the chance of serious harm if you caught the disease.
Talk to your doctor about possible side effects of shingles vaccines, or if you have possible side effects that worry you.
Common side effects of shingles vaccines include:
- pain, redness, swelling or itching where the needle went in
Serious reactions to immunisation are rare. With Zostavax® vaccination, very rarely a generalised chickenpox-like rash may occur around 24 weeks after vaccination. This may be associated with fever and feeling unwell. This rash may be a sign of a serious reaction to the virus in the vaccine. Seek medical attention and inform of recent Zostavax vaccination if you experience this reaction.
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Who Should Not Get The Shingles Vaccine
The vaccine may not be appropriate for people who have a weakened immune system due to certain conditions. These people include those with an organ transplant and those who are undergoing chemotherapy to treat cancer.
Doctors also recommend that people with an allergy to any component of the vaccine do not have the shingles vaccination.
Anyone with severe allergies must tell a doctor about them when discussing their shingles risk. People who are pregnant or breastfeeding or currently have shingles symptoms should not get the shot.
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What Everyone Should Know About The Shingles Vaccine
Shingles vaccination is the only way to protect against shingles and postherpetic neuralgia , the most common complication from shingles.
CDC recommends that adults 50 years and older get two doses of the shingles vaccine called Shingrix to prevent shingles and the complications from the disease. Adults 19 years and older who have weakened immune systems because of disease or therapy should also get two doses of Shingrix, as they have a higher risk of getting shingles and related complications.
Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.
Shingrix provides strong protection against shingles and PHN. In adults 50 years and older who have healthy immune systems, Shingrix is more than 90% effective at preventing shingles and PHN. Immunity stays strong for at least the first 7 years after vaccination. In adults with weakened immune systems, studies show that Shingrix is 68%-91% effective in preventing shingles, depending on the condition that affects the immune system.
What Else To Know About The Shingles Vaccine
Ready to get vaccinated? This is the essential info on how the shots are given, what to expect with side effects, and more.
You need two doses of Shingrix to get full protection from shingles. You should get your second dose 2 to 6 months after the first. Your doctor or pharmacist will inject the vaccine into the muscle of your upper arm, so wear clothes that give easy access to that area.
If it has been more than 6 months since you got your first dose, go ahead and get your second dose. You donât need to start over, Dooling says.
Because Shingrix is so new, experts arenât sure whether youâll eventually need another shot, or a booster, years down the road.
âThe CDC is actively following how protected people remain after the two-dose series,â she says. We know that after 4 years, protection remains above 85%. Only time will tell how durable that protection is.â
You do not have to wait between Shingrix and COVID-19 vaccination. The CDC has determined its safe to get the COVID-19 vaccine at the same time as Shingrex, but recommends they be given in different arms. You should not get eithe vaccine if you have COVID.
Side effects are fairly common. You may have heard that people sometimes have unpleasant side effects soon after they get the shingles vaccine.
âShingrix tends to have has more side effects than some vaccines, like those for the seasonal flu,â says Kistler. The shingles vaccine may cause:
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