For older people, the common question regarding shingles is, “Is shingle shot covered by insurance?”. When my grandmother was bedridden from shingles, I asked myself the same question to my doctor since, without insurance, shingle shot is expensive.
Even though I would have paid the total amount if they weren’t, the cost is too much for a vaccine older people after fifty need every 5-7 years. For low-income people, getting the shingle vaccine may not be a possibility.
That is why I want people to know how insurance affects shingle costs and how it might be possible to reduce the costs.
About Shingles
All of us have heard about chickenpox. The virus that causes chickenpox, varicella-zoster virus, also causes shingles. Another name for shingles is herpes zoster.
Shingles are the reactivation of the chickenpox virus. After getting affected by chickenpox, the virus lies dormant in our bodies. It happens even if we are cured of the disease.
What Kind of People Get Shingles?
When our immune system gets weak, there is a possibility that we might get infected by shingles. It is more common in people over forty and fifty. And the chance of getting infected rises as we get older.
That is to say; younger people can get it. The probability of virus reactivation relies on our autoimmune system.
In such cases, people over 19 can get the Shingrix vaccine as a preventive measure. The current statistics show that one in three people in the US will get infected by shingles.
That is why it is better to be extra careful regarding the time of the shingles vaccine after getting the two doses.
Why Should We Be Wary of Shingles
Shingles cause a tremendous amount of pain. Patients have described it as a ‘stabbing’ or ‘burning’ feeling.
This pain can last for months or years. It is a kind of nerve pain; thus, relief from it is hard to achieve. Some people had a long-term hearing or eye issues in some rare severe cases.
Usually, shingles go away after two to four weeks but cause a severe rash in their wake. Other harmful complications of this disease are post-herpetic neuralgia (PHN), pain in the rash areas, scarring, vision problems if the rash occurs near the eye, and weakness in the affected nerve areas.
Paralysis might occur from nerve damage like facial paralysis. Plus, there is a chance that different skin infections may affect you on the off-chance that rashes are not adequately treated.
Types of Shingle Vaccine
Two types of vaccines are known to prevent shingles with different levels of effectiveness. They are Shingrix and Zostavax.
There is also some other difference between the two. Zostavax is a live vaccine. The vaccine is a weak shingle virus that can boost the body’s immune system by acclimating it to the said virus.
On the other hand, Shingrix is a non-living vaccine. People get nervous when they hear that the vaccine is a live one. That is one of the reasons Shingrix is more popular.
According to CDC (Centers for Disease Control and Prevention), in people older than sixty, Zostavax can prevent the reactivation of the shingle virus by 51%. However, in the same situation, Shingrix guarantees prevention up to 91% or lower.
Shingles can last more than five years, while Zostavax only protects the body for five years. But patients vaccinated with Zostavax need one shot of vaccine for immunization, not two shots of vaccine like Shingrix.
Older patients (over seventy) were recommended Zostavax as their bodies cannot handle the side effects of vaccines within a few months. Plus, you can get Shingrix even if you get Zostavax.
Discontinuation of Zostavax
In November 2020, Zostavax was discontinued in the US. There were significant reasons behind it. The primary reason is that it is not as effective as Shingrix.
Its protection duration is also shorter. Since it contains a live virus, people with the weak immune system cannot get it.
Yet there is a correlation between a weak immunodeficiency system and age. The older we get, the more our body’s defence mechanism weakens.
So, Zostavax requires time-consuming patient screening that is very frustrating to both patients and doctors. Shingle is also a common disease.
For a vaccine to not apply to vulnerable age demography is unacceptable. The FDA (Food and Drug Administration) also noted in their initial press release that those people who were given the shot experienced more severe complications than those who were given the placebo.
Some Zostavax patients also reported eye problems such as blurred vision, blindness, etc. As a result, the manufacturers are facing lawsuits from patients due to all of the reasons.
In this way, Zostavax is not distributed in the US anymore. So now, when patients ask, “Is shingle shot covered by insurance?” they mean Shingrix.It is possible to find them in other countries, though.
Medicare and Shingrix
I have bad news for those who want to get a Shingrix shot with Medicare. Medicare does not consider this vaccine in preventive service.
If it did, like flu shots, it would be covered by Medicare Part B. Since it is a prescription drug, you must cover the costs yourself.
It can amount to 200 dollars per dose of vaccine. One of the reasons behind this high price is that there is no generic drug for shingles.
Another reason is that Medicare considers Shingrix a tier 3 or 4 medication. And as we know, the higher the tier, the more it costs.
A way in which Medicare can cover Shingrix is through its Part D plan. It depends on the plan you are on.
Yet you might have to co-pay, pay and then get cashback or cover the deductible. The first step to getting Medicare insurance is to be eligible for it. However, when people are first eligible for Medicare, they get Part A or Part B plans.
These plans do not cover Shingrix. You might also not prefer Part D. If you want Part A and B advantages with Shingrix, you can get a Medicare Advantages Plan.
Advantages plans are a mix of all the parts, and some of them cover Shingrix! Private companies that Medicare approve of making these plans.
You can compare Medicare plans and find one suitable for you. For example, you have to cover the deductible if you don’t have a significant medication need.
So, Part D might not be a good fit for you here. On the other hand, someone with a colossal prescription list might benefit more from Medicare Part D prescription drug plan.
How To Cover Shingrix Through Insurance
Vaccine Assistance Programs
The bureaucratic system of the American medical field is complex enough that people have to arm themselves with a game plan to get their medicines and vaccines under their insurance. Otherwise, the costs are too much to continue with treatment plans.
People might not know this, but pharmaceutical companies sponsor people to cover their vaccine costs if they are eligible for immunization. It’s good PR for them.
Most of the time, the pharmaceutical manufacturing company here, the company behind Shingrix, will provide vaccine assistance programs. It can be an option if you cannot afford a shingle shot.
Other than them, many welfare programs and NGO institutions offer free immunization to at-risk people. Even if you are not at risk, see if you can be on their assistance sponsorship list.
Private or Corporate Insurance Plan
Most companies nowadays offer medical insurance in their salary to attract people. Reliance on this insurance can backfire if you don’t check thoroughly what the insurance plan entails.
Their drug plan might not cover all your medications. If you want to add other medical insurance with your company’s coverage plan, it can cancel the corporate plan you are on.
These things are not easy to navigate, so another option for you might be getting private medical insurance. This plan makes most commercial drugs cheaper, and Shingrix is considered a commercial drug.
There can be additional costs as private, and company insurance will sometimes not cover the entire drug price. To lessen the cost, see if your insurance covers pharmacies.
Some pharmacies offer a lower price than others. All in all, getting a Shingrix vaccine injection from pharmacies is the cheapest option. It is the answer to, “Is shingle shot covered by insurance?”
When Not To Get Shingrix
Even if your insurance covers Shingrix, there are certain instances where you should not get the vaccine.
A. After you get the first dose of Shingrix, please notice if you have any allergic reaction to it. If you have one, it is better not to get the second dose.
B. Before getting the Shingrix vaccine, look over the list of components in it. There is a chance that you might be allergic to one of them.
If that is the case, the shingle shot is not suitable for you. A severe allergic reaction can cause irrecoverable harm to your body.
C. The effect of Shingrix was not studied by researchers on pregnant or breastfeeding women. So, they are advised not to get the vaccine.
D. If you currently have shingles.
E. If you are not immune to the shingle virus, the chickenpox virus. Here, not resistant means that you never had chickenpox.
Without getting chickenpox, you won’t get shingles. So, rather than getting the Shingrix vaccine, it’s better to get the chickenpox one.
The above circumstances are some general reasons why Shingrix can harm you. But it is always better to consult your doctor, primary medical caregiver, or pharmacist before getting the shingle vaccine.
Your insurance might cover the vaccine cost, but we should not neglect how Shingrix can influence our health.
Side Effects of Shingrix
Every medicine or vaccine has some side effects. Depending on the person, the result of the consequences can be mild or critical. Some common symptoms after getting Shingrix are,
- Upset stomach or diarrhoea
- Headache
- Muscle pain since the vaccine is injected into the muscle group
- Nausea
- Swelling or pain in the injected site
- Fatigue
- Fever
- Shivering
If the side effects do not disappear after a few days, it is time to consult your doctor. Also, you might experience breathing difficulty, hives, swelling in the throat and face, and weakness.
In this case, you need immediate medical attention as these are signs of critical complications.
Frequently Asked Questions
- When was Shingrix approved by the FDA?
The distribution and manufacture of Shingrix were approved in October 2017 by FDA.
- What does Shingrix vaccine do?
It prevents the possibility of contracting shingles and reduces nerve pain if shingles are employed.
- Do I need prescription to get Shingrix?
No, you don’t. Shingrix is a necessary vaccine for the older age demographic.
- How much does Shingrix cost in CVS?
It costs about $ 180 to $ 200 per dose. So, for two doses, you will need to pay a maximum amount of $ 400.
- Is Shingrix covered by Blue Cross?
Yes! Shingrix is covered by the Blue Cross and Blue Shield of Illinois insurance.
- Where is shingle shot injected?
It is injected in the muscle of the arm.
- Is Shingrix covered by Medicare?
Generally, it is not. But some Medicare packages do cover it.
- How much does Shingrix cost at Walmart?
Its retail price is $ 284 there.
Conclusion
Everyone in the US has to be concerned about their insurance as medication has a steep price. In the case of Shingrix, people first want to know, “Is shingle shot covered by insurance?”.
Since this vaccine is expensive without insurance coverage, we have to check if it covers it carefully when we plan to get a specific prescription drug plan. There is a chance for almost all adults to get shingle.
Moreover, shingle shots can also reduce the pain of shingles, which is quite intense. Getting a dose of vaccine, with or without insurance, is a must.