Does Medicare pay for the Shingles vaccine?

Shingles

What is Shingles?

Shingles is a skin rash caused by a nerve and skin inflammation from the same virus that previously caused chickenpox. This virus is called the varicella zoster virus and belongs to the herpes family of viruses.Anyone who has ever had chickenpox is at risk of shingles, which is caused by a reactivation of the dormant chickenpox virus. You can get shingles at any age, but the risk increases dramatically as you get older and your immune system becomes less effective. Each year up to one million Americans, more than then 60 or older, are diagnosed with shingles. This represents 15% of the adults age 60 and over in the United States.

What are the symptoms of shingles?

You are probably wondering, since the shingles virus comes from the same virus as chickenpox, are the symptoms the same as chickenpox? Shingles usually starts with a headache and then a rash on a band or section of skin, typically on one side of the face or body. Symptoms can also include general achiness and fatigue, fever and chills. The rash then turns into clusters of blisters, which fill with fluid and crust over. Itching can also be a symptom. Shingles can be very painful. The virus travels along nerve pathways, causing inflammation and damage. The pain tends to be more severe and last longer in older people. In the worst cases, the shingles virus can cause blindness, if it infects the eyes or the area around your eyes, as well as hearing problems, brain inflammation (encephalitis) or death. Mild scarring usually occurs where shingles appear on the skin. If you believe you may have shingles you should seek medical attention promptly.

Is the shingles virus contagious?

Shingles is contagious and can be spread from an affected person to babies, children, or adults who have not had chickenpox. But instead of developing shingles, these people develop chickenpox. Once they have had chickenpox, people cannot catch shingles (or contract the virus) from someone else. Once infected, however, people have the potential to develop shingles later in life

How are shingles diagnosed?

Shingles are diagnosed by characteristic painful blisters localized to the region of a specific nerve. This is usually sufficient for a diagnosis of shingles. No diagnostic tests are usually required. However, individuals who have impaired immune function may require additional medical testing because the shingles may sometimes not display the characteristic clinical pattern.

What is the treatment for shingles?

There are several effective treatments such as antiviral medications for shingles which can reduce the severity and duration of the rash if the medication is started within 72 hours of the appearance of rash. It is important to seek medical attention quickly if you think you may have the shingles vaccine so treatment can begin and you can receive symptomatic treatment to make the duration of the virus as comfortable as possible. Pain medication may be needed for symptom control. Both nonsteroidal anti-inflammatory medications and narcotic medication may be used for pain management for the symptoms of shingles.

Is there a vaccination to prevent shingles?

Yes, there is a vaccine that will provide protection against shingles and the need, if any, for booster shots. The vaccination is called Zostavax. A study of nearly 200,000 patients in the year 2000 reported by the Journal of Internal Medicine found the shingles vaccine to be “generally safe and well tolerated.” The vaccine reduces your risk of shingles by 51% according to one large study, but does not eliminate it, and the vaccine does not treat or lessen lingering nerve pain from a past outbreak. Researchers are still trying to determine how long a dose of Zostavax vaccine provides protection against shingles and the need, if any, for booster shots.

Does Medicare pay for the shingles vaccine?

While your original Medicare Part B does not cover the shingles vaccine, the government requires that all Medicare Part D (also known as “PDP”) plans do. In most cases the patient will obtain a prescription from their physician and actually get the vaccine from a pharmacy. In cases where there is a trained pharmacist on staff at the pharmacy the patient can receive the injection at the pharmacy; however, in most cases the patient will take the vaccine back to their physician to administer the injection in a medical setting. Co-pays may apply for the physician office visit.

How much does the vaccine cost?

Since there is not a generic version of the Zostavax vaccine then the patient’s out-of-pocket costs will depend on which Brand Tier the medication is assigned in a specific prescription drug plan formulary. Typically, the vaccine ranges from $60 to $80. It is recommended that anyone over the age of 60 receive the shingles vaccine.

Medicare Pathways wants you to stay healthy and take advantage of all treatment and vaccinations that are available to you, as recommended by your physician. If you are unsure if the shingles vaccine is covered by your prescription drug plan, contact a Benefit Specialist who will assist you in determining which Brand Tier the vaccination is categorized and the out-of-pocket costs and if deductibles apply. You can also consult your Part D formulary, or simply ask your physician to check for you.

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Comments

  1. Carolyn Cornwell says:

    I have Medicare and Blue Cross. I went to drug store, medicare does not pay for shingles vaccine. The pharmacy charges $240.00. I did not get the vaccine. I have had shingles once but my doctor thinks I still should get the shot. I am 75 years old. What is my next step. My doctor does not administer the vaccine.

    • While your original Medicare Part B does not cover the shingles vaccine, the government requires that all Medicare Part D (also known as “PDP”) plans do. In most cases the patient will obtain a prescription from their physician and actually get the vaccine from a pharmacy. In cases where there is a trained pharmacist on staff at the pharmacy the patient can receive the injection at the pharmacy; however, in most cases the patient will take the vaccine back to their physician to administer the injection in a medical setting. Co-pays may apply for the physician office visit.
      Since there is not a generic version of the Zostavax vaccine then the patient’s out-of-pocket costs will depend on which Brand Tier the medication is assigned in a specific prescription drug plan formulary. Typically, the vaccine ranges from $60 to $80. It is recommended that anyone over the age of 60 receive the shingles vaccine

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