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Patients Upset As GPs Run Short Of Shingles Vaccine In $826m Plan
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Why Enrolling In Medicare Part D Is Important
Advertisement AdvertisementJanuary 27, 2024 at 12:00 p.M.
Toni,
I was told to receive a shingles vaccination. I need to be enrolled in a Part D prescription drug plan for the vaccination to have a $0 copay or pay $200. I thought all vaccinations and immunizations are covered at no cost under Medicare Part B.
Can you explain this Medicare rule? Thank you.
— Carl from Lubbock, Texas
Carl,
On Jan. 1, 2023, the Inflation Reduction Act eliminated all out-of-pocket costs for vaccines recommended for adults by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. This important Medicare change went into effect whether you have drug coverage from a stand-alone Medicare Part D prescription drug plan or from a Medicare Advantage plan with Part D coverage. The shingles vaccine, also known as Shingrix, is included at no cost.
Carl,
Advertisement AdvertisementShingles Vaccine: Should I Get It?
Shingles is a viral infection caused by the chickenpox virus. It can cause an itchy, painful rash. Some people experience burning pain at their rash site for months or even years after the shingles rash has cleared.
There is one vaccine available in the U.S. To protect against shingles. Shingrix (RZV), a zoster vaccine, was approved in 2017 and it is more than 90% effective in preventing shingles. With Shingrix, protection lasts an estimated 7 years.
Doctors recommend Shingrix 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.
If you're pregnant or breastfeeding, experts recommend that you wait to get Shingrix.
Shingrix is the only FDA-approved vaccine available in the U.S. That provides protection from shingles.
Shingrix vs. Zostavax
An earlier shingles vaccine called Zostavax was removed from the market in 2020. That vaccine used a weakened form of the chickenpox virus to send your body's immune system into action to fight the disease. Shingrix uses a dead version of the virus to teach your immune system to recognize and protect against it.
If you received the Zostavax vaccine, it is recommended that you also receive Shingrix, which is much more effective at reducing your risk of shingles.
To be fully protected, you'll need to get two doses of the Shingrix vaccine. After your first shot, you'll get the second dose 2 to 6 months later.
Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. If you've had chickenpox at any time in your life -- and 99% of adults born in the U.S. Before 1980 have had it, even if they don't remember it -- then the virus that can cause shingles is already dormant, or inactive, in nerve tissues in your spinal cord. There, the virus can stay quiet for decades. Later in life, it can reactivate as shingles.
Shingles causes painful, itchy rash that can appear on your face or body. If it affects the eyes, it can cause vision loss. In some people, most often those with issues that affect their immune system, the rash can spread widely over the body. In rare cases, it can cause pneumonia, hearing problems, brain inflammation, or death.
Your risk of developing shingles goes up as you age or if you're immunocompromised. When the virus wakes up, it causes itching and tingling feelings in your skin that can last up to 5 days. This happens before a blister-like rash appears on your body or face, often in a strip on one side of your body. You also may have a fever, an upset stomach, headache, and chills.
The rashes tend to go away within a month, but shingles can lead to long-term nerve damage and pain, especially in people over 50 or who are immunocompromised. Fluid from shingles rashes can spread the virus from person to person.
About 1 in 3 people in the U.S. Will get shingles in their lifetime, or about 1 million people a year. It can happen at any age, but you're more likely to have it as you get older.
Doctors say most healthy people over 50 should get Shingrix, as well as anyone 19 or older who is immunocompromised, even if you can't remember having chickenpox. Most people have been exposed to chickenpox even if they didn't develop symptoms.
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.
There are a few situations in which shingles vaccination may not be right for you. You should not get Shingrix if you've ever had a severe reaction to a vaccine. This means you had trouble breathing or swelling in your mouth or airway, a life-threatening condition called anaphylaxis.
You should also skip Shingrix if:
If you have a disease or take medications that affect your immune system, talk to your doctor about the pros and cons of Shingrix.
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 don't need to start over.
There is no Shingrix vaccine shortage. If you tried to get vaccinated for shingles sometime in 2018 or 2019, your doctor or pharmacist may have told you that they were out of the vaccine, but you should be able to get it now.
How often should you get the shingles vaccine?
Because Shingrix is so new, experts aren't sure whether you'll eventually need another shot, or a booster, years down the road.
Shingrix can make the area where you get the shot swell or feel sore. Other effects include:
Younger people are more likely to have these side effects, and they typically last 2 or 3 days.
It's 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.
Yes. While Shingrix is approved generally for people 50 and older, the FDA has also approved its use for those aged 19 years and older who are or will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by disease or therapy.
You can get the shingles vaccine at your doctor's office or at most pharmacies. If you're planning to pay for the vaccine with Medicare Part D coverage, confirm that your doctor or pharmacist can bill your plan directly before you go.
Wherever you get the vaccine, you will have to go back in 2 to 6 months to get your second dose.
Medicare Part D covers the cost of a shingles vaccine. If you have private health insurance, check your plan. Some insurers will pay for it after age 50 and others at 60. Call your insurance company before you get the vaccine to check if it's covered.
Shingles vaccine cost
Out-of-network costs are usually low, often around $5 a shot.
If you're uninsured and have met your Medicare Part D out-of-pocket spending limit, you may be able to get Shingrix at no cost. It depends on your income. The vaccine's manufacturer, GSK, has a patient assistance program called GSK For You that could help you get the vaccine for free. Check their website for more details.
Shingrix is highly effective, but it's still possible to get the virus after you've been vaccinated. The good news is that if you do still get shingles after getting the vaccine, you're more likely to have milder symptoms and to be sick for a shorter amount of time. You're also at less risk for complications like postherpetic neuralgia, or lingering pain around the site where you had the shingles rash.
Shingrix is the only shingles vaccine available in the U.S. Experts recommend that anyone aged 50 and older get vaccinated for shingles, as well as those 19 and older who have or will have weakened immune systems. Shingrix significantly lowers your risk of developing a painful shingles rash. Ask your doctor if you should get the vaccine.
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