Shingles vaccine

[ziggy29]

Quote:

Originally Posted by audreyh1 Apparently BCBS has changed their policy!!! The pharmacist said he thought insurance companies had been under a lot of pressure since the FDA reduced the age for the vaccine to 50. It would have cost $240.

Getting ready for open enrollment here, and I noticed that on my plan with a different insurance company, too -- shingles is now covered at age 50+ rather than 60+ as a preventative care benefit which is covered 100%, first-dollar.

Since I just turned 50 a couple weeks ago (koff koff), I suppose it's something I could do now if I decide the benefits outweigh the risks at my age.

[Nords]

Quote:

Originally Posted by ziggy29 Getting ready for open enrollment here, and I noticed that on my plan with a different insurance company, too -- shingles is now covered at age 50+ rather than 60+ as a preventative care benefit which is covered 100%, first-dollar. Since I just turned 50 a couple weeks ago (koff koff), I suppose it's something I could do now if I decide the benefits outweigh the risks at my age.

The threshold was dropped to age 50 a few years ago. We got it as soon as we could.

Talk with people who've had shingles-- I suspect you'll conclude that the rewards are far better than the risks, and the pain is not worth it at all.

[MBAustin]

My primary doctor said I should get it but suggested I go to a walk-in clinic as it would be cheaper - she didn't think it would be covered so I'd have to pay full price as I haven't met my (high) deductible this year. I went to my favorite Minute Clinic in CVS and found out that the vaccine has to be kept frozen and not all CVSs have a freezer - if they do, the shot is given by the pharmacist, not the Minute Clinic. Very interesting. And they only keep a few doses on hand so she suggested calling in advance.

[Lakewood90712]

I'm the youngest and not yet 60 , older sister is also not 60 and her HMO will not pay, she works in a hospital, so maybe it's a good idea for her to pay out of pocket, and claim as an employee expense ?.

My mom swears I was the only one of her brood that did not get chicken pox. For some reason she is also quite sure I did not get the smallpox vax back when it was s.o.p. for school in the 1960's.

Would I be at risk getting chicken pox if I got the shingles vax , can I get tested to see if I already have chicken pox antibodies ?

One more thing , I am my mom's caregiver , she has a weak immune system. Would I be somehow be putting her at any risk if I got the shingles vax ?

[Alan]

I would check with your mother's physician if she should get the vaccination.

Shingles vaccine: Should I get it? - Mayo Clinic

Quote:

The shingles vaccine isn't recommended if you: Have ever had an allergic reaction to gelatin, the antibiotic neomycin or any other component of the shingles vaccine Have a weakened immune system due to HIV/AIDS or another disease that affects the immune system Are receiving immune system-suppressing drugs or treatments, such as steroids, adalimumab (Humira), infliximab (Remicade), etanercept (Enbrel), radiation or chemotherapy Have cancer that affects the bone marrow or lymphatic system, such as leukemia or lymphoma Are pregnant or trying to become pregnant

Quote:

Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles.

[omni550]

Is there a way to test if you have had chicken pox?

An acquaintance of mine (age early 70s) claims he never had chicken pox and recently got shingles. His was on his torso. A few weeks later it is still quite painful (he says it feels like a bad sunburn that won't go away) whenever he is wearing clothing, walking or riding in a vehicle. He says he stays home a lot as a result and basically stays in the nude to reduce the pain.

omni

[Nunthewiser]

I already said it once on this thread, but unless you are eating cat food for dinner tonight, take it from me and Terry Bradshaw, get the vaccine. At first I thought I was passing a kidney stone, then it got worse. Never had such pain, and it lasted for weeks...

[O2Bfree]

Quote:

Originally Posted by omni550 An acquaintance of mine (age early 70s) claims he never had chicken pox and recently got shingles. His was on his torso. A few weeks later it is still quite painful (he says it feels like a bad sunburn that won't go away) whenever he is wearing clothing, walking or riding in a vehicle. He says he stays home a lot as a result and basically stays in the nude to reduce the pain. omni

My mom had them back in February, 8+ months ago. They ran across her back and under her breast, and are still painful enough that she can't wear a bra. Unfortunately, she is well-endowed, and at 86 really needs one, so it's put a damper on her social life because there's only a few outfits she feels comfortable wearing in public.

[tmm99]

Quote:

Originally Posted by Lakewood90712 I'm the youngest and not yet 60 , older sister is also not 60 and her HMO will not pay, she works in a hospital, so maybe it's a good idea for her to pay out of pocket, and claim as an employee expense ?. My mom swears I was the only one of her brood that did not get chicken pox. For some reason she is also quite sure I did not get the smallpox vax back when it was s.o.p. for school in the 1960's. Would I be at risk getting chicken pox if I got the shingles vax , can I get tested to see if I already have chicken pox antibodies ? One more thing , I am my mom's caregiver , she has a weak immune system. Would I be somehow be putting her at any risk if I got the shingles vax ?

Yes you can get tested for the antibody. I got the test done before I got the shingles vaccine. I told my doctor I wasn't sure if I had had chicken pox and she ordered the test for me.


Sent from my iPhone using Early Retirement Forum

[swakyaby]

I called my insurance today, Blue Shield of California, to find out if the shingles vaccine is covered at my age of 54. First, I was gently criticized for not going to the explanation of benefits on their website first. Then she said the vaccine is 100% covered at age 60 when given by PCP. When I asked if that meant I would pay 100% out of pocket, she said no. She noted that I had already met my deductible for the year, and said that my cost is only 20% of the allowed amount. But that is only if I get the vaccine at my primary care doctor's office.

[ziggy29]

Quote:

Originally Posted by swakyaby I called my insurance today, Blue Shield of California, to find out if the shingles vaccine is covered at my age of 54. First, I was gently criticized for not going to the explanation of benefits on their website first. Then she said the vaccine is 100% covered at age 60 when given by PCP. When I asked if that meant I would pay 100% out of pocket, she said no. She noted that I had already met my deductible for the year, and said that my cost is only 20% of the allowed amount. But that is only if I get the vaccine at my primary care doctor's office.

I think the change in FDA approval for shingles vaccine from 60+ to 50+ is recent. It's possible that it might change from 60 to 50 in some plans on January 1, since most (all?) ACA-compliant plans are following FDA guidelines for determining when vaccinations are treated as covered preventative care.

[audreyh1]

Quote:

Originally Posted by ziggy29 I think the change in FDA approval for shingles vaccine from 60+ to 50+ is recent. It's possible that it might change from 60 to 50 in some plans on January 1, since most (all?) ACA-compliant plans are following FDA guidelines for determining when vaccinations are treated as covered preventative care.

FDA announced the change to 50 years in March of 2011. So it's been over 4 years now.

[Gotadimple]

Quote:

Originally Posted by swakyaby I called my insurance today, Blue Shield of California, to find out if the shingles vaccine is covered at my age of 54. First, I was gently criticized for not going to the explanation of benefits on their website first. Then she said the vaccine is 100% covered at age 60 when given by PCP. When I asked if that meant I would pay 100% out of pocket, she said no. She noted that I had already met my deductible for the year, and said that my cost is only 20% of the allowed amount. But that is only if I get the vaccine at my primary care doctor's office.

I think I'd call them again and if you get the same answer, ask to speak to a supervisor. If federal law has changed, they need to follow it, or tell you why they don't have to.

[tfudtuckerpucker]

According to the CDC, the shingles vaccine does not have a recommendation for ages 50-60. Or am I reading this incorrectly? Under what conditions should a doctor approve this for ages 50-60, so that it's covered under the ACA?

"Shingles vaccine is approved by FDA for people aged 50 years and older. However, CDC does not have a recommendation for routine use of shingles vaccine in people aged 50 through 59 years old. Adults aged 50 through 59 years who have questions about the shingles vaccine should discuss the risks and benefits with a health care provider. There are no long-term studies showing how long the vaccine is effective in 50 to 59 year olds. In adults vaccinated at age 60 years or older, protection from the vaccine decreases within the first 5 years after vaccination. "

[omni550]

I spoke with the (age 70-ish) acquaintance who just got shingles a few weeks ago. He had held off getting the shot due to the ~$250 cost plus he always thought he'd never get shingles.

He mentioned that he has since found out that Medicare covers all but $5 of the cost of the shingles shot for those on Medicare. Can someone confirm?

Also, now that he's had shingles and is dealing with the ongoing nerve pain, he said he'd pay $250 just to avoid the pain, fwiw.

omni

[Ronnieboy]

Answers to some questions:

1) Is it recommended at age 50 or 60?

The FDA had lowered their recommended vaccination of shingles to 50 years old, the CDC has kept it at 60 years old. This is why every insurance company has a different answer. Some have followed the FDA and will pay for it at 50+, others are following the CDC and won't pay till 60+ (another way to keep costs lower for them??). <<-- BTW, this is a trick that all insurance companies use to not pay for certain drugs. If the Doctor prescribed you an expensive medication, but is using it for off labeled use then the insurance company can deny the claim saying it hasn't been approved by the FDA for that specific use even if the off-labeled use is well documented to work.

"Update on Recommendations for Use of Herpes Zoster Vaccine

Weekly

August 22, 2014 / 63(33);729-731

Craig M. Hales, MD1, Rafael Harpaz, MD1, Ismael Ortega-Sanchez, PhD1, Stephanie R. Bialek, MD1 (Author affiliations at end of text)
Herpes zoster vaccine (Zostavax [Merck & Co., Inc.]) was licensed in 2006 and recommended by the Advisory Committee on Immunization Practices (ACIP) in 2008 for prevention of herpes zoster (shingles) and its complications among adults aged ≥60 years (1). The Food and Drug Administration (FDA) approved the use of Zostavax in 2011 for adults aged 50 through 59 years based on a large study of safety and efficacy in this age group (2). ACIP initially considered the use of herpes zoster vaccine among adults aged 50 through 59 years in June 2011, but declined to recommend the vaccine in this age group, citing shortages of Zostavax and limited data on long-term protection afforded by herpes zoster vaccine (2). In October 2013, ACIP reviewed the epidemiology of herpes zoster and its complications, herpes zoster vaccine supply, short-term vaccine efficacy in adults aged 50 through 59 years, short- and long- term vaccine efficacy and effectiveness in adults aged ≥60 years, an updated cost-effectiveness analysis, and deliberations of the ACIP herpes zoster work group, all of which are summarized in this report. No vote was taken, and ACIP maintained its current recommendation that herpes zoster vaccine be routinely recommended for adults aged ≥60 years" (ACIP=CDC)

2) Should I get it if I haven't had the chicken pox?

The short answer is YES. It is believed that pre chicken pox vaccinations (1990) that the majority of people had been exposed to or had the chicken pox, but due to light or no symptoms, the possibility that they were never officially diagnosed or that it was forgotten that little John or Mary had them 50 years ago. You'd be safer to get the vaccination.

3) Am I contagious after I get the shingles shot?

While the vaccine is a live virus, it is inactivated so it cannot replicate to cause the full on disease when injected. You do want to have a healthy immune system when you get the vaccination to have the best results (protection) from the vaccine. There are no documented cases that you can spread chickenpox (to varicella virgins) or shingles to another person from the vaccination.

But if you develop shingles itself you are contagious until blisters stop forming and are crusted over.

4) Does my insurance cover it?

Tricky question. I have seen every Tricare plan cover all vaccinations for zero copay. Easiest way to find out is to stop by your pharmacy and ask them to give you a shingles shot, let them know that you want to find out the price before you are going to get it. If it comes out at the cash price $220-275 then say no thanks or as other people have said, that is a small price to pay for moderate protection from the shingles. Another option is to call the insurance number on the back of your card, I'd call the pharmacy benefit first as almost all immunizations are being pushed to pharmacies as a less expensive alternative than the MD office.

Medicare part D - pharmacy coverage will pay for the shingles vaccine. There are a few caveats. Have you hit your deductible? If so you probably want to get it done before the end of the year, before the reset button gets hit. If you haven't maybe you should wait till January and have a big chunk of it taken care of with your shingles shot. Many part D copays run from $45 to $90 (after deductible).

[Amethyst]

My Dr. also said I needed to be 60 before she'd order a shingles vac, but she didn't cite insurance cost and probably doesn't care. I didn't argue. I was too busy getting the flu shot that she DID want me to have.

Mr. A. had shingles some years back; even though his was a "mild" case, and cleared up quickly with medication, I sure don't want it.

Quote:

Originally Posted by bmcgonig I just called Blue Shield CA to see if I can get one for free and they said that I had to be 60 or over. Different here I guess. Sent from my iPad using Early Retirement Forum

[Meadbh]

Quote:

Originally Posted by omni550 Is there a way to test if you have had chicken pox? An acquaintance of mine (age early 70s) claims he never had chicken pox and recently got shingles.

Yes. Chickenpox antibodies can be measured in a blood sample.

https://labtestsonline.org/understan...npox/tab/test/

Also, your friend did have chickenpox in the past. Not everyone who is infected with chickenpox gets the typical rash. Shingles is due to emergence of the chickenpox virus from its hiding place in the dorsal spinal nerve roots. When chickenpox antibody tests are done, it is quite common for people with no history of chickenpox to have chickenpox immune globulin in their blood (IgG, which takes weeks to appear after being infected).

[Bamaman]

We went on vacation earlier this year, and the wife spent her nights itching and itching. Fortunately she had some Neurotin with her--a prescription medicine--that stopped most of the itch.

As we got home, she broke out with a rash on her neck/face and she peeled in those places. Looking back, she had a very minor case of the shingles while we were on our trip. Had she not taken the Shingles Vaccine earlier, my wife would have had a full blown, painful case of the shingles.

[ivinsfan]

Hopefully it was the shingles and not bedbugs, my number one fear when I get a rash away from home...