Shingles vaccine

[Ronnieboy]

The cash price at Costco is about $200. I've been told $230-$250 from Walgreens, WalMart, Rite-Aid and CVS.
In the early stages it was only approved at age 60+ so most insurances didn't cover below 60. Now the FDA has said 50+ but the Advisory Committee on Immunization Practices (ACIP) still kept the recommendation at 60+, supposedly both due to supply shortage and lack of data on long term protection (it is possible that if you received your immunization at 50 y.o. you could need a 'booster' later in life, only time will tell).

That is why some insurances might still be only paying for 60 and older. If you have medicare part D (drug coverage) it should be covered at your local pharmacy for no more than a $90 copay (unless you haven't met your deductible) better are less than $90 to $0 as Tricare holders can attest (same with some other insurances). Best bet is to call the toll free number on the back of your Medicare Part D card and ask, "What is my copay for Zostavax at my local pharmacy?"

As far as pain, it is subcutaneous so not in the muscle (like Tdap, Flu, pneumonia, etc) and usually not painful at all. Site reaction is biggest side effect (redness or irritation where it was injected), second is headache in 1 out of 3 people.

This new vaccine sounds interesting, but I would not wait for it to come out if I were in the target age range. First the time it will take for it to come out....multiple years, second even though they are not doing studies whether you can get the second shot if you've had the first, chances are you would be able too, as there haven't been any issues with 'over vaccination'. When you go to the Dr after stepping on a rusty nail, if you can't remember when you had your last tetnus shot they don't say, 'lets wait on it till you can check your records' you just get another vaccination.

Since Zostavax protects about half the people from getting the rash and almost 70% from the post herpatic pain (the worst part from what I hear) you'll probably want the zostavax vaccine now and the new one from GSK when it comes out anyway.

Last but not least, it is assumed everyone born before 1990ish (chicken pox vaccine was widely available after 1995) has either been exposed or has had the chickenpox. You or your parents might not have remembered it, it might have been mild, it might have been misdiagnosed, it might not have even shown up, but you have the virus in your system so you can get the shingles.

My question is, since the chicken pox vaccine (Varicella) is a live vaccine, getting that theoretically gives you the virus so you would then have the possibility of getting shingles later....without ever having the chickenpox.....

PS I am not employed by MERCK (zostavax) or GSK

[audreyh1]

That's a good overview. I plan to get the vaccine now (55) and I don't see waiting for a new one with no history. If I need a "booster" shot at 65, so be it.

[razztazz]

Quote:

Originally Posted by athena53 What changed my mind was a fellow student in my Geology class, in her 20s, who mentioned one day that she'd had a shingles attack over the weekend and the pain was so bad she was in tears. .

Was this really a case of shingles? My understanding is shingles last way longer than just a weekend. Altho I have heard of people in their 20's getting shingles

[razztazz]

Quote:

Originally Posted by ChainsBeGone I have Tricare Retiree for insurance and for them the minimum age is 50. Not sure what the vaccine costs as it was administered to me at a military medical treatment facility so I did not see a bill.

How long ago did you get your shot? I have TriCare too and just last night checked their website and they age Sixty (60)

[FIYes]

The grandchild of a friend got the shingles. He never had chicken pox but had had the chicken pox vaccine. He is elementary school age. So yes, apparently it is possible to get shingles even if you have only had the vaccine and not chicken pox.




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[ERD50]

Quote:

Originally Posted by FIYes The grandchild of a friend got the shingles. He never had chicken pox but had had the chicken pox vaccine. He is elementary school age. So yes, apparently it is possible to get shingles even if you have only had the vaccine and not chicken pox. ...

Another explanation is that maybe the child did have a very mild case of chicken pox, and no one was aware of it? I understand this can happen, and vaccines are not always 100% effective, but may still help to make the case more mild, so that would tie in with them not knowing.


-ERD50

[Koolau]

Have been trying to get the vaccine for "free" (aka, paid for by someone else) for 2 years. Everyone (Walgreens, CVS, etc.) said $200 to $300. I finally called my CVS drug benefit card and they said, "oh, yeah. it's included at no cost." Slight pain upon injection and very mild pain at sight for a couple of days. Hoping it is effective for me. DW had shingles years ago - it was NOT pretty and it WAS very painful. YMMV

[mickeyd]

Received it about 10 years ago at a local military hospital at no cost to me. I do not recall having any reaction and I have not had a single episode of shingles.

My dear mother had shingles that lasted about 10 years until she died. She was always in a lot of pain.

[ERD50]

I finally called my ins co, this is a new deal for me since MegaCorp changed the retiree heath care policy. They used to self-administer, now we go to the exchanges, but get some reimbursement.

The person on the phone had some odd accent that I couldn't place (French sounding?), didn't seem to understand 'vaccination', but fortunately I did my home work, and gave him the name of the vaccine (Zostavax). He put me on hold, and eventually informed that 'immunizations' are preventative and 100% covered, no co-pay, nothing, and didn't mention any age restrictions (I'm 60, DW turns 60 later in the year). Now that I search for 'immunization' in my policy pdf, that matches. Then I checked that my local Costco was in-network for this, and that was affirmative.

So I will 2x check with Costco (may need to schedule, I think this vaccine is kept refrigerated?), and DW and I will go in and get this done.

Both my son and his wife had shingles a few years apart (still in their 20's), though a pretty mild case for each.

This thread has helped to keep this on my mind - thanks!

-ERD50

[Telly]

Quote:

Originally Posted by ERD50 So I will 2x check with Costco (may need to schedule, I think this vaccine is kept refrigerated?), and DW and I will go in and get this done. -ERD50

It's refrigerated, but it only takes a few minutes to mix it up. I called (not Costco) first to make sure they had it in stock, then went over. No appt. needed.

The group plan that we have covers 100% as preventative all CDC-recommended vaccinations. I just look up the latest chart on CDC's website. When I go into the pharmacy or Minute-Clinic, they run my ins. card to verify with our ins. co. that it is indeed 100% covered, before they do anything.

[Teacher Terry]

My hubby got shingles & it was very painful in addition to leaving a scar on his face. I was going to get one but then read that if you are allergic to neomycin do not get one.

[Bikerdude]

Quote:

Originally Posted by Telly It's refrigerated, but it only takes a few minutes to mix it up. I called (not Costco) first to make sure they had it in stock, then went over. No appt. needed. The group plan that we have covers 100% as preventative all CDC-recommended vaccinations. I just look up the latest chart on CDC's website. When I go into the pharmacy or Minute-Clinic, they run my ins. card to verify with our ins. co. that it is indeed 100% covered, before they do anything.

When I had the shot at a chain pharmacy I could swear he took something off the shelf before I received the shot. Maybe it was the syringe. From what I read the zoster vaccine must be kept frozen until reconstituted and then used within 72 hours.

[ERD50]

Got my shot today, after years of procrastination.

Two weeks ago, I called my insurance co to make sure it was covered, they said yes (after a long hold). I made sure that Costco was a place I could go (got prescriptions filled there before), they said yes (after more holds). I asked, no co-pay, no $ at all? They said yes, immunizations are 100% covered as 'preventative'. OK. And later, I find this in my plan booklet that I downloaded.

Well, Costco rings it up at $217.xx they said the ins co listed it as a 'plan exemption'. Hmmm. I decide to pay now, get the shot, and challenge the ins co for a reimbursement. Will make that call tomorrow.

I'm actually OK paying out of pocket, based on what I've heard from people who have had shingles. But if the ins said they'd pay, they better pay.

Also, when they gave me the shot, they made a big deal about how it is going to sting. Well, I'm pretty much a wimp on these things (though shots or giving blood don't bother me much), but the sting was pretty mild and short lived. No soreness at all at this point. Hopefully no problem tomorrow, though dealing with the ins co will not be good for my blood pressure.

-ERD50

[audreyh1]

I got my shot today at Costco. I promised myself I would get it when I was 55 and my year is almost up!

After waiting (shopping) 15 mins while they got stuff ready, I was completely blown away when they told me I owed $0. I was totally expecting to pay for this since I am on a high deductible health insurance plan (HSA compatible).

Luckily Costco had my insurance on file and checked for me while I was off shopping. I just assumed it would not be covered since I was under 60, as that is what happened to my husband 2 or 3 years ago.

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.

There was a syringe and two vials (one with silver or white seal, one green), FWIW.

If we find out in 10 years that I need another one or some kind of booster - no prob.

[bmcgonig]

Quote:

Originally Posted by audreyh1 I got my shot today at Costco. I promised myself I would get it when I was 55 and my year is almost up! After waiting (shopping) 15 mins while they got stuff ready, I was completely blown away when they told me I owed $0. I was totally expecting to pay for this since I am on a high deductible health insurance plan (HSA compatible). Luckily Costco had my insurance on file and checked for me while I was off shopping. I just assumed it would not be covered since I was under 60, as that is what happened to my husband 2 or 3 years ago. 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. There was a syringe and two vials (one with silver or white seal, one green), FWIW. If we find out in 10 years that I need another one or some kind of booster - no prob.

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.


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[eytonxav]

Got the vaccination several years ago, no pain afterwards and no shingles to date.

[audreyh1]

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

Wow, bummer. I was very surprised.

[ERD50]

Quote:

Originally Posted by audreyh1 I got my shot today at Costco. I promised myself I would get it when I was 55 and my year is almost up! After waiting (shopping) 15 mins while they got stuff ready, I was completely blown away when they told me I owed $0. ...

It didn't work that way for me (look back ~ 4 posts).

When I first called, they said I would need to wait for the EOB to show up in the system. I called a few weeks ago, after no EOB, and explained it all, and they said I need to submit as a Medical Claim, that it would be covered since they told me to go on that phone call. So I did that (they need the originals for everything, arggghhhh). I see today, it did show up, and says it needs to be processed by such and such dept, and will be denied if not ordered by my PCP. Well, I'm sure this will be another fight.

-ERD50

[Rustic23]

I ran into this, don't know how much of it is based on regulations, or 'They say'.

I have TriCare for life as my provider of drugs.

They say it has to be given by PCP. PCP said they don't give it, you get it at the drug store, or such. Tricare says if it is not given in the PCP office, they will not cover it. Waited about a year, and finally my PCP said they would give it. Turns our, as I take very few drugs, I did not meat the deductible, and paid most if not all the cost of the shot. Close to $200, I think. No real complaints considering what Medicare and Tricare covers.

[MBSC]

Quote:

Originally Posted by Rustic23 I ran into this, don't know how much of it is based on regulations, or 'They say'. I have TriCare for life as my provider of drugs. They say it has to be given by PCP. PCP said they don't give it, you get it at the drug store, or such. Tricare says if it is not given in the PCP office, they will not cover it. Waited about a year, and finally my PCP said they would give it. Turns our, as I take very few drugs, I did not meat the deductible, and paid most if not all the cost of the shot. Close to $200, I think. No real complaints considering what Medicare and Tricare covers.

Quote:

TRICARE covers the shingles vaccine, Zostavax, for beneficiaries 60 and older. You can get the vaccine at a participating TRICARE network pharmacy or at your doctor’s office. You can get the shingles vaccine for free at a participating network pharmacy. If you want to get the shingles vaccine at your doctor’s office... if you're using TRICARE For Life, you'll pay: TRICARE's deductible and cost share.

Source: Is It Covered? - Shingles Vaccine

Also:

Quote:

1) You may receive the shingles vaccine at no cost at a participating TRICARE retail network pharmacy. Be sure to call the pharmacy first to see if there are any restrictions. 2) You may receive the shingles vaccine from your doctor’s office. However, because Medicare does not cover the vaccine, TRICARE For Life (TFL) will be processing the claim as primary payer when received at a provider’s office. When TFL pays as primary, there is a $150.00 deductible and then a 25% cost-share (TFL will pay 75% of the allowed amount after the deductible has been met).

Source: Shingles and Tricare for life - Topic