Wednesday, May 29, 2024

Will My Insurance Pay For Shingles Vaccine

What Vaccines Can Help Prevent Shingles

Relief coming to those on Medicare who can’t afford shingles vaccine

There is currently one vaccine available in the U.S. to prevent shingles. Shingrix was approved in 2017 and it is more than 90% effective in preventing shingles. With Shingrix, you get two shots between 2 and 6 months apart and protection lasts an estimated 4-5 years. Doctors recommend it for healthy people over 50 as well as those 19 years of age and older who are or will be immunodeficient or immunosuppressed due to disease or therapy..

An earlier vaccine called Zostavax was removed from the market in 2020. That vaccine used a weak form of the chickenpox virus to send your bodyâs immune system into action to fight the disease. Shingrix does not. If you received the Zostavax vaccine, it is recommended that you also receive Shingrix.

How To Save Money On Vaccines

If youre uninsured or having trouble paying for your vaccines, talk to your CVS pharmacist.

GoodRx offers discounts on vaccines as well as medications. You can print or show the CVS pharmacist a GoodRx coupon. For the shingles vaccine Shingrix, for example, you can save as much as 22% off the average retail price. Another GoodRx coupon can help save as much as 36% off a Tdap vaccine.

Counseling Patients About Shingrix

Know the benefits and side effects of Shingrix so youre prepared to talk with your patients before administering the vaccine.

What to tell patients about Shingrix benefits:

  • You can protect yourself against shingles. Shingles is a very painful disease, and your risk of getting it increases as you age. Also, you are more likely to have severe, long-term pain if you get shingles when you are older. About 1 out of every 3 people in the United States will develop shingles in their lifetime.
  • Shingrix provides strong protection against shingles and long-term pain from the disease. Two doses of Shingrix are more than 90% effective at preventing shingles. So its very important that you get this vaccine.

What to tell patients about Shingrix side effects:

What to tell patients about dose two:

  • You need to come back in 2 to 6 months for your second dose. We can make that appointment now.
  • Even if you have side effects from the first dose, it is important to get the second dose to build strong protection against shingles. Your reaction to each dose may be different just because you have a reaction to the first dose does not mean that you will have a reaction to the second.

Also Check: When Is Shingles Contagious To Others

Pain And Complications Of Shingles In Elderly People

Older adults who develop shingles are often surprised at how painful it is. Many say that it is far more painful than the original chickenpox virus that affected them in childhood. Often the skin in the area of the rash continues to hurt even after the rash has healed.

The individual may feel stabbing or throbbing or even weakness. Doctors call this post-herpetic neuralgia, and it can sometimes last for months or even years.

There are also risks for older adults who develop shingles. The blistered area of skin can become infected, requiring antibiotics in addition to antivirals. Such infections can lead to scarring. The rash is also uncomfortable and makes it challenging to rest. When healing takes longer than usual, some individuals can feel despair or even depression. In rare cases, it can lead to encephalitis.

The virus can also be transmitted to other parts of your body, such as your eyes or lips. The herpes virus can cause outbreaks that may affect hearing and vision.

Another thing to be concerned about is contagion. While shingles itself is not contagious, the virus that causes it is. If your spouse has never had chickenpox and has not been vaccinated, he or she could develop chickenpox as an adult. Its important to keep your skin clean and dry and prevent it from rubbing against any other person who could get infected.

Do I Need A Prescription For A Shingles Vaccine

Shingles Vaccine for Adults Over 60

Once you have a Medicare insurance plan that covers the shingles vaccine, youll need to find out whether a prescription is necessary. This is dependent on where you get vaccinated. You wont need a prescription if you get vaccinated at your doctors office.

Some pharmacies that provide vaccines do so under the standing order of a supervising physician. This is convenient for patients because it saves them a trip to the doctors office to acquire a prescription before receiving the vaccine. You may need to call your pharmacy to see how they handle shingles vaccine orders.

If your pharmacy requires a prescription, youll need to contact your medical provider first. They may want to see you in the office beforehand, but not always. Sometimes, the doctor may give you the shingles vaccine at your appointment.

Once you have the prescription in your possession, the remaining steps are pretty straightforward. Take the prescription to a pharmacy in your plans network to be filled. A pharmacist will administer the vaccine in their clinic area.

Its possible to save money on shingles vaccines with a SingleCare pharmacy savings card. SingleCare coupons can help uninsured or underinsured patients get shingles vaccines at a discounted price.

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What Are The Complications Of Shingles

The most common and lasting complication of shingles is nerve pain, whats called postherpetic neuralgia , which can last for months or even years, long after the rash has cleared up. According to the CDC, between 10% and 18% of people whove had shingles will develop PHN.

PHN is a stabbing or throbbing pain or weakness where the shingles rash had been. The risk increases with age and the pain lasts longer and is more severe than in younger people.8

In rare cases, shingles can develop into pneumonia, hearing problems, blindness and brain inflammation.9 Only 1% to 4% of people with shingles are hospitalized for complications, though these are typically older adults and people whose immune systems are weak or suppressed, and fewer than 100 people die from shingles each year.10

What Are The Side Effects

Shingrix can make the area where you get the shot swell or feel sore. Other effects include:

  • Many people who get the vaccine have muscle aches, headaches, or feel tired.
  • About 1 in 4 people have a fever or an upset stomach.

Younger people are more likely to have these side effects, and they typically last 2 or 3 days.

Itâs also possible to have an allergic reaction to an ingredient in the vaccine. If you have problems breathing, feel your face or throat swelling, or feel weak or dizzy after the shot, call 911 and get medical help right away.

Read Also: Where Can Shingles Be On Your Body

Cdc Shingles Vaccine Recommendations

The Centers for Disease Control and Prevention recommends Shingrix vaccination for everyone 50 years and older and those 19 years and older who have weakened immune systemseven if you have already had shingles, if you had another type of shingles vaccine, and if you dont know whether or not youve had chickenpox in the past.

You should not get the vaccine if you have a severe allergy to any of the components, currently have shingles, or you have lab tests that definitively show that you do not have antibodies against the varicella-zoster virus. In that case, you may be better off getting the varicella vaccine instead. Also, those who are pregnant should consider delaying vaccination with Shingrix until after delivery.

Is The Shingles Vaccine Covered By Medicare

Medicare & You: Vaccines

The CDC recommends people 50 years and older get the shingles vaccine. The shot is widely available and the cost may be covered if you have Medicare Advantage or Medicare Part D. Depending on your plan, you may have to cover a deductible, co-pay, or pay for the shot out of pocket and get reimbursement.

Shingles can cause serious complications, like painful long-term nerve damage. To stay safe from such complications, you may want to consider the new shingles vaccine . An older vaccine once widely administered in the U.S. was less effective and is no longer on the market.

Read Also: What Do I Do If I Have Shingles

How Much Do Vaccines Cost At Cvs

Here are the retail costs for several in-demand vaccines at CVS Pharmacy:

In-demand vaccines
Tdap $77

If you live in an area that has both CVS Pharmacy and MinuteClinic, compare prices and insurance coverage. You may be able to get a slightly better price by shopping around. You may also be able to ask one store to match the price of the other.

How Much Does The Shingles Vaccine Cost

The amount you pay for the shingles vaccine will depend on how much your Medicare plan covers. Remember that if you only have original Medicare and no prescription drug coverage through Medicare, you may pay full price for the vaccine.

Medicare drug plans group their medications by tier. Where a drug falls on the tier can determine how expensive it is. Most Medicare drug plans cover at least 50 percent of a drugs retail price.

PRice ranges for the shingles vaccine

Shingrix :

  • Deductible copay: free to $164 for each shot
  • After deductible is met: free to $164 for each shot
  • Donut hole/coverage gap range: free to $74 for each shot
  • After the donut hole: $7 to $8

To find out exactly how much you will pay, review your plans formulary or contact your plan directly.

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Don’t Overpay: Advice For Medicare Patients

Three out of four Americans eligible for the shingles vaccination still havent gotten it, according to the CDC. Not surprisingly, a 2015 report from the National Vaccine Program found that one of the main reasons adults skip recommended vaccines is the cost.

If youve been putting off getting your shingles shot because you were quoted a high price, check your Part D plan. You may be able to get it for less.

Confusion about insurance coverage for the vaccine can sometimes result in patients paying more than they should, Avitzur says.

Dont delay, as the consequences of shingles can be devastating, advises Avitzur, a neurologist who has seen firsthand the painful effects of lingering nerve damage.

Your best bet may be to get the shot at a pharmacy in your drug plans network. Youll still need to get a prescription from your doctor, but the pharmacy will bill your insurance company and youll pay the lowest out-of-pocket costs available under your plan.

If you would like to get vaccinated at your doctors office, ask up front about the cost. Does your doctor charge more to administer the shot than your plan allows? If so, youll be on the hook for the difference. Also see whether the office will bill your Part D or Medicare Advantage plan directly or work with a pharmacy in your network to handle the billing.

Do I Have To Make An Appointment

Does Medicare Pay For Shingles Shots?

The COVID-19 vaccine requires making an appointment ahead of time at CVS.com. Most other vaccines are available on a walk-in basis. Same-day appointments are often available online. You can also answer the vaccine-specific questionnaire online instead of filling it out in person.

You may want to call ahead to your local CVS Pharmacy and make sure your desired vaccine is in stock. You can also check to see if theres a wait at the store or clinic.

Read Also: What Medicine Is Prescribed For Shingles

Does Medicare Cover Shingles Vaccines In 2022

Shingles is a viral infection caused by the varicella-zoster virus . It produces a painful rash with fluid-filled blisters and typically shows up on one side of the body. The same virus that causes chickenpox causes shingles. Anyone who has had chickenpox in the past is at risk of getting shingles.

Shingles is a painful rash that occurs along the distribution of a nerve, called a dermatome, says Erum N. Ilyas, MD, a fellow of the American Academy of Dermatology and founder of AmberNoon. The virus lays dormant in the nervous system. Immunity likely plays a role in preventing the virus from reactivating. When immunity is low, the virus replicates and spreads down the nerve causing pain, inflammation, and blistering.

The Centers for Disease Control and Prevention recommends that adults older than 50 get the shingles vaccine. Shingles can cause long-term nerve pain and nerve damage. Getting two shingles vaccine doses two to six months apart has proven to be very effective at preventing shingles.

Shingrix is a brand-name shingles vaccine and is currently the only shingles vaccine available in the United States. Zostavax, a previous zoster vaccine, wasdiscontinued in 2020.

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Why Is The Shingles Vaccine Recommended

The Centers for Disease Control and Prevention recommends that healthy adults 50 years and older get two doses of Shingrix two to six months apart to prevent shingles and complications from the disease. The vaccine is typically administered to adults who are 50 years and older. There is no maximum age for getting Shingrix.

It is also given to those who have received a live zoster vaccine in the past.

The studies report that two doses of Shingrix will be more than 90 percent effective at preventing shingles and its complication called postherpetic neuralgia.

The vaccine protects you at least 85 percent of the time for the first four years after vaccination.

You should get Shingrix even if you have a history as follows:

  • Already had shingles

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Can You Get Shingles If You Had The Chickenpox Vaccine

It depends. Anyone who has ever had chickenpox is susceptible to shingles. When the chickenpox virus comes out of hiding and reactivates, it causes numbness, tingling, blisters, and sometimes flu-like symptoms. If you never had chickenpox because you were vaccinated, you run a very low risk of getting shingles.

How Can I Get A Shingles Vaccine

Shingles Vaccine Info

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

Also Check: Getting Shingles Vaccine At Cvs

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.

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Also Check: How Long Does Shingles In The Eye Last

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.

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