Producer Online News
Shingles vaccine now covered at pharmacyJanuary 29, 2013
On January 1, 2013, we began pharmacy coverage of the brand-name vaccine, Zostavax. This is a one-time-only adult immunization against the shingles virus. At this time, there is no generic alternative for Zostavax.
Because the shingles vaccine needs special handling, many doctors have stopped making it available in their offices, making it harder for members who want to get the immunization.
Where should members get their one-time-only shingles immunization?
- Older adult members can get the shingles vaccine at a participating network pharmacy.
- Many major pharmacy chains, such as CVS, Rite Aid and Walgreens, take part in the shingles immunization program. We encourage people to call the pharmacy first, to make sure it is in the shingles vaccine program and has the serum in stock. They might also want to confirm whether a doctor's prescription is needed to get the vaccine, as this may vary.
- Members also may get their shingles vaccine through their doctor, if he or she stocks the serum in the office.
- If the doctor doesn’t stock the vaccine in the office, he likely will refer patients to a pharmacy for their shot.
How is the benefit paid?
All prescription drug plans, except generic-drug-only plans (there is no generic for Zostavax ), include this now. However, benefits will vary from plan to plan, based on whether the plan is “grandfathered,” meaning that it does not include the preventive care provisions of the Patient Protection and Affordable Care Act (PPACA).
- Members on a non-grandfathered plan will not need to pay a cost share.
- Members on a grandfathered plan – one that did not implement the PPACA preventive care provisions –may pay a cost share based on their benefit design.
What is shingles?
Shingles is a painful skin rash caused by the varicella zoster virus*. This is the same virus that causes chickenpox. Shingles most often appears in a band, a strip, or a small area on one side of the face or body. It is also called herpes zoster.
Anyone who has had chickenpox can get shingles. It most commonly occurs in older adults and people who have weakened immune systems due to stress, injury, certain medicines, or other reasons. Most people who get shingles will get better and will not get it again. Sometimes, it can have lingering side effects, such as nerve pain, which is another good reason to get the vaccine and avoid getting shingles in the first place.