Medicare Part D prescription drug plans do cover the shingles vaccine (stand-alone Medicare Part D plans and Medicare Advantage plans that include drug coverage). However, coverage (and cost) of the vaccine can vary depending on your chosen Medicare prescription drug plan, vaccine, and the pharmacy where you have the vaccine administered.
Please note, Medicare Part B (out-patient care) does not cover the shingles vaccine, but you can have your doctor administer the vaccine in their office Your doctor probably cannot charge your Medicare Part D plan for the vaccine, so you can pay your doctor out of pocket, and then ask your Medicare Part D plan to reimburse you for the cost of the vaccine.
As noted by Medicare: "Shingles shot - How often is it covered?
The shingles shot isn’t covered by Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). Generally, Medicare prescription drug plans (Part D) cover all commercially-available vaccines (like the shingles shot) needed to prevent illness. Contact your Medicare drug plan for more information about coverage."
(https://www.medicare.gov/coverage/shingles-vaccine.html)Coverage of the Shingrix ® vaccineUpdate April 18, 2018:
Please note that the new shingles vaccine Shingrix
® (approved by the FDA in October, 2017), is not yet included in the Medicare.gov Plan Finder (as of April 18, 2018),
signifying that it is not yet covered by any Medicare Part D plans in the large metropolitan areas that we checked.
In January 2018, the CDC released the statement:
"CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine called Shingrix®, separated by 2 to 6 months, to prevent shingles and the complications from the disease. Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.
Shingrix provides strong protection against shingles and postherpetic neuralgia (PHN). Two doses of Shingrix is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated. Shingrix is the preferred vaccine, over Zostavax®, a shingles vaccine in use since 2006."
In light of the positive remarks by the CDC (see below), we are
hoping Shingrix will be added to Medicare Part D plan drug lists
(formularies) within the next few months. For more information about
coverage of Shingrix, please speak with your Medicare Part D plan's
Member Services department and ask when the plan will be adding Shingrix
to their formulary.
You can also ask your Medicare Part D plan about a Formulary Exception
whereby the plan would provide coverage for a non-formulary drug. You can click on the following link to learn more about Formulary Exceptions and the appeals process should your plan deny your Formulary Exception request: https://q1medicare.com/PartD-DrugListExceptionAppealGrievance.phpCoverage of the Zostavax ® vaccine
As reference, the shingles vaccine, Zostavax® was approved in May 2006 by the U.S. Food and Drug Administration (FDA) as a vaccine for use in adults ages 60 and over who have had chickenpox.Zostavax
is covered by most Medicare Part D plans, however Zostavax can be treated differently depending on the plan.
In most cases Zostavax
is treated as a Tier 3 or Tier 4 medication and in some cases requires prior authorization or falls into the step therapy program. Please check with your specific Medicare Part D plan to determine the handling of Zostavax.
Additional medications listed as treatments for Shingles are:
Valtrex (generally a Medicare Part D Tier 3 medication) and
Protopic (generally a Medicare Part D Tier 2, 3 or Tier 4 medication - in some cases requiring prior authorization or step therapy)
For more information, please see our FAQ: "Can the co-pays for the shingles vaccine (Zostavax) vary by the pharmacy where purchased and administered?
Please remember: We are not physicians, nor are we pharmacists. The above information is strictly for informational purposes. Please consult your doctor or pharmacist when determining treatments.
Click the link below to see a list of how Zostavax
is handled on all stand-alone Medicare Part D plans in Florida: https://q1medicare.com/PartD-SearchPDPMedicarePartDDrugFinder.php?stateReg=11FL&ndc=00006496341&drug=ZOSTAVAX%20VIAL