You Can Get A Shingles Vaccine Two Ways:
At the pharmacy. Youll still need a doctors prescription, but once thats been transmitted, you can get the shot at a retail pharmacy.
Most major chains and some independent pharmacies can administer the vaccine. Just make sure to use a store in your drug plans network so that it can bill your plan directly and youll owe just the copayment.
At the doctors office. If youre vaccinated in a doctors office, check whether it can bill your drug plan directly or works with a pharmacy that can do so. If so, it will work as mentioned above, with you owing a copayment. If not, you may need to pay the full cost up front and then file a claim for reimbursement from your plan.
Remember that the doctors fee for administering the vaccine may exceed your plans allowable charge, in which you case youre on the hook for the difference. It pays to check beforehand.
Editor’s note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.
Which Medicare Providers Cover The Shingles Vaccine
Even though all insurance plans for Medicare Plan D offer some level of coverage for the shingles vaccine, the typical cost for the vaccine will vary. Your actual cost will depend on your plan details and if you’ve already met your deductible.
Typical costs based on available plans in Charlotte, NC , Boston, MA , and Los Angeles, CA
Why A New Shingles Vaccine
Did we need a new shingles vaccine? To answer that question, it helps to have a bit of background on this infection.
Shingles, which is also called herpes zoster, occurs when the chickenpox virus , which is dormant in those whove had the illness, reawakens later in life. Almost all adults older than 40 carry the chickenpox virusand the older we get, the more the risk of getting shingles climbs. According to the CDC, the infection strikes about 1 million people in the U.S. each year and nearly one in three adults will experience a bout of shingles in their lifetime.
The two to four weeks of shingles, marked by symptoms such as a blistery and painful rash on one side of the body, can be difficult enough. But about one in five people with shingles go on to develop postherpetic neuralgia, or PHN, which is nerve pain that can linger for months or even years.
Since 2006, weve had Zostavaxapproved for those between 50 and 59 but recommended by the CDC for adults 60 and olderas the sole bulwark against shingles. Zostavax offers 70 percent protection against shingles for people between 50 and 59 but only 18 percent in people 80 and older, according to the Pink Sheet, which reports on the pharmaceutical industry.
When all ages are taken into consideration, Zostavax cuts the chance of shingles by only 51 percent and the risk of PHN by 67 percent.
Shingles is a big problem with immunocompromised people, Schaffner says.
You May Like: Tdap Cvs
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.
Some Vaccines Covered Better Than Others
Unlike the flu and pneumonia vaccines, which are fully covered as preventive services under Medicare Part B, the shingles shot and other recommended vaccinations are covered as prescription drugs under Medicare Part D and Medicare Advantage plans.
Some of those plans provide better coverage than others, but nearly all of them divide their formularies, or list of covered drugs, into tiers according to cost. Drugs in Tier 1 and 2, mainly lower-priced generics and preferred brand-name drugs, have lower co-pays than more expensive nonpreferred brands in Tier 3 or 4.
Consumer Reports found that many Part D plans categorize the shingles vaccine, Zostavax, as an expensive Tier 3 or 4 drug. Only one pharmaceutical companyMerckmakes the shingles shot, and theres currently no generic version.
That means if you havent met your annual deductible, youll likely wind up paying full price for the shot, which is about $217. But depending on your plan, even after the deductible is met, consumers may have to pay a significant part of the shingles vaccine costup to $100.
Many healthcare providers havent set up billing systems to file claims through prescription drug plans. So if you’re vaccinated at your doctors office, you might be required to pay the full shingles vaccine cost up front and then file to be reimbursed by your insurance.
Read Also: Can I Get Tdap At Cvs
Who Should Not Get The Shingrix Vaccine
Most healthy people aged 50 and older should get the Shingrix vaccine, even if they meet the criteria listed above. However, there are some groups of people who should not receive the Shingrix vaccine. These include:
People who have had a severe allergic reaction to any ingredient of the Shingrix vaccine or the vaccine itself.
People who have tested negative for immunity to the virus that causes shingles, the varicella zoster virus. People who test negative should receive the chickenpox vaccine instead.
People who currently have shingles.
People who are currently pregnant or breastfeeding.
People who have a moderate or severe acute illness, including those with a fever of 101.3 degrees Fahrenheit or higher. These people should wait to receive the vaccine until they recover.
What Are Shingle Vaccine Side Effects
The shingles vaccines are safe and effective, but they can cause side effects. Common side effects include headache, fever, and fatigue. Nausea, vomiting, and diarrhea are other common side effects.
A person may experience soreness, redness, and swelling on the site where the vaccine was given. People who get the Zostavax vaccine may experience a rash and itching on the site.
After you get the vaccine, stay at the clinic for at least 20 minutes. The staff will make sure you’re good to go. They will also make sure you don’t suffer a severe allergic reaction.
A person who experiences a severe allergic reaction to the vaccine will manifest different symptoms. These include hives and swelling of various parts of the body. Shortness of breath is another symptom that can come up.
If the staff determines a person has a severe allergic reaction, they will call 9-1-1. This type of issue is a life-threatening condition that requires immediate treatment. A person who suffers a severe allergic reaction after leaving the clinic should report it to their health care provider.
Also Check: Can You Get Tdap At Cvs
Guidance On Reporting Adverse Events Following Immunization
Vaccine providers are asked to report AEFIs through local public health officials and to follow AEFI reporting requirements that are specific to their province or territory. In general, any serious or unexpected adverse event felt to be temporally related to vaccination should be reported.
For LZV the following AEFIs are also of particular interest and should be reported:
- Suspected transmission of vaccine-strain virus to a close household or occupational contact. This phenomenon has been documented following varicella vaccine but it is rare, and transmission has not been documented with LZV.
- Recurrent HZ following immunization of individuals with a history of HZ prior to immunization, noting the area of recurrence.
- Recurrent HZO following immunization of a person who has had a previous episode of HZO. If available, a vitreous fluid specimen should be sent to a laboratory with a request to determine whether the virus is the vaccine strain or wild type virus.
For definitions of serious and unexpected adverse events, refer to Adverse events following immunization in Part 2.
For more information refer to Reporting Adverse Events Following Immunization in Canada.
How Much Does Shingrix Cost Without Insurance
The price of Shingrix without insurance is around $241.70 for 1, 50MCG/0.5ML Suspension Reconstituted. However, you can save significantly on the price of your prescription drug when you use SingleCare. Shingrix coupons from SingleCare will reduce your total to $183.33 for Shingrix even without insurance. Ask your local pharmacist to run your discount card to compare Shingrix prices before you overpay for another prescription.
You May Like: Does Cvs Give Tdap Shots
Who Should Not Get Shingrix
You should not get Shingrix if you:
- have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix
- tested negative for immunity to varicella zoster virus. If you test negative, you should get chickenpox vaccine.
- currently have shingles
- currently are pregnant or breastfeeding. Women who are pregnant or breastfeeding should wait to get Shingrix.
If you have a minor acute illness, such as a cold, you may get Shingrix. But if you have a moderate or severe acute illness, you should usually wait until you recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.
The side effects of the Shingrix are temporary, and usually last 2 to 3 days. While you may experience pain for a few days after getting Shingrix, the pain will be less severe than having shingles and the complications from the disease.
Is It Possible To Get Shingles Twice
Most people who get shingles only experience it one time in their lives. However, it is possible to get shingles more than once . This is known as recurrent shingles. Getting vaccinated can help minimize the chance that this will happen.
These are only a few of the many questions people may have about Shingrix. To learn more about the vaccine and shingles, individuals can consult a medical professional.
Recommended Reading: Can You Get A Tdap Shot At Cvs
Shingrix Is Not A Live Vaccine
A live vaccine is one that contains a weakened form of a germ. Shingrix is not a live vaccine. Its an inactive vaccine, which is a vaccine thats made from a germ thats been killed.
Because Shingrix is inactive, more people can receive it. This includes people with a weakened immune system .
People with weakened immune systems are typically advised against receiving live vaccines. This is because on very rare occasions, live vaccines can mutate back to the full-strength germ that causes a disease.
If this happens, people with weakened immune systems would have a much higher risk for developing the disease that the vaccine is meant to prevent.
Shingrix is also a recombinant vaccine. This means that its made of parts of the shingles virus, such as protein, sugar, or capsid .
There used to be an alternative shingles vaccine to Shingrix. This other vaccine was called Zostavax.
Like Shingrix, it was approved to prevent shingles . However, Zostavax is
Below, we briefly describe the similarities and differences between these two vaccines.
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.
Don’t Miss: Cheapest Shingles Shot
What Are The Risks Of Shingles
About one in five people who get shingles will have severe pain after the rash goes away. This pain can last months or even years. This pain is known as post-herpetic neuralgia.
Rare complications of shingles include scarring, pneumonia, loss of hearing or vision, swelling of the brain and bacterial superinfections of the rash.
How Much Will You Pay For Shingles Vaccines
You can find the shingles vaccine on your Part D plan formulary or listing of covered medications. Check to see into which tier the vaccine falls the tier will define how much your insurer will pay and how much you will have to pay.14
If your doctors office will provide the vaccination, check to be sure they can bill your plan directly. That way, youll have only the copay. Otherwise, you may have to make the full payment upfront and file with your plan for reimbursement. Also, check to be sure that the doctors fee for administering the shot is covered as part of your plans allowable charge.13
Youll probably pay the least amount out-of-pocket by being vaccinated at a pharmacy thats within your drug plans network. But if you havent met your deductible for the year on your drug plan, you may pay full price for the vaccine.
If you havent had your shingles vaccine yet and youre selecting a Medicare Advantage plan during the Open Enrollment Period, be sure its one of the medications on whatever plan you choose.
Recommended Reading: Cvs Tdap
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.
The Food and Drug Administration approves vaccines such as Shingrix to prevent certain conditions.
Shingrix Far More Effective Than Previous Shingles Vaccine
Shingrix was 97 percent effective overall in clinical trials at reducing shingles cases. The older Zostavax vaccine reduced overall shingles incidence by 51 percent.
The shots are less effective as people age. But Shingrix still showed an improvement over the older vaccine. Shingrix was almost 90 percent effective for people 70 and older. Zostavax track record has been 67 percent for people 60 and older.
People receive Shingrix in two shots. They should get the second one between two and six months after the first. People who have had the older Zostavax shingles vaccine should wait at least eight weeks before getting a Shingrix shot.
Don’t Miss: How Much Is The Tdap Vaccine At Cvs
Does Medicare Cover The Shingles Vaccine Will I Have To Pay For The Shot
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.
Other Types Of Plans Do Better
Other forms of insurance do a far better job covering immunizations.
Under provisions of the Affordable Care Act, private planssuch as insurance through your employer or purchased on a state marketplaceare still required to cover recommended vaccinations as preventive medical care, not drugs.
That means that as long as you go to a provider in your plans network, your insurance will pay for preventive care without a co-pay, even if you havent met your deductible.
Its really a shame that older Americans, who are most at risk of contracting shingles and most vulnerable to the potentially serious effects of the disease, often have to pay more than others for the vaccine, says Consumer Reports medical director, Orly Avitzur, M.D.
If youre currently covered by a private health plan but anticipate going on Medicare in the next five years or so, one cost-saving strategy is to talk to your doctor about updating all your vaccinations now while your insurance provides good coverage, Avitzur says. The shingles shot is recommended for nearly all adults aged 60 and older.
Read Also: Tdap Booster Cvs
Whats The Cost Of The Shingles Vaccine
According to GlaxoSmithKline, manufacturer of Shingrix, the two-shot series costs people with Medicare Part D an average of $50 per shot.15
As of October 2021, discount-coupon company GoodRx lists Shingrix at around $160, which is about 23% off its reported average retail price of $206.73.16 It indicates that Medicare plans list Shingrix typically in Tier 3 of their formulary. 17
Ultimately, how much your vaccine costs depends on the Medicare prescription plan or Medicare Advantage plan you choose, the vaccine you get and the pharmacy or doctors office where you have it administered.
If the shingles vaccine cost is unaffordable for you, GlaxoSmithKline has a Patient Assistance Program GSK for You that may be able to help you with the cost.
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.
Read Also: Cvs Dtap Vaccine