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?
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).
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.