2020 Plan Finder Part D, ShingRx, and frequency

[harllee]

Shingrix is is not a "medical procedure" it is a vaccine and, at least under Medicare it comes under the Part D pharmacy coverage. Not sure about whether there is still a shortage since we have now had both shots. I had a terrible case of Shingles over 15 years ago and I still suffer from post herpetic pain. When the new Shingles shot came out I made it a priority to get it, spent many hours tracking the shots down, finally had to drive several hours away to get the second shot. I would say whatever you have to do GET SHINGRIX. I would give anything not to have had Shingles.

 

[CardsFan]

Shingrix is is not a "medical procedure" it is a vaccine and, at least under Medicare it comes under the Part D pharmacy coverage. Not sure about whether there is still a shortage since we have now had both shots. I had a terrible case of Shingles over 15 years ago and I still suffer from post herpetic pain. When the new Shingles shot came out I made it a priority to get it, spent many hours tracking the shots down, finally had to drive several hours away to get the second shot. I would say whatever you have to do GET SHINGRIX. I would give anything not to have had Shingles.

Bold by me.

Many (most?) Pre-medicare plans code it as a medical procedure, and cover it that way. That is the reason for some of the coverage confusion.

 

[badatmath]

Hmm, well I get flu shots at doc office, wouldn't it be same? I guess I thought all preventive stuff was covered. I have an appointment coming up, will ask if they have the vax. The fact so many of you are concerned about this tells me its important even though I don't know anyone who has had shingles.


** It just occurred to me my insurance is all one "plan" for drugs and doctors so that must be the difference? So once medicare age that all changes? I mean I knew you all had a drug plan but *preventive* changes too?

 

[Winemaker]

Update on our clawback from Walgreens/Highmark regarding Shingrix. After Monday's call to Highmark, our $1800/month insurer, the customer service rep assured DW that it was a covered expense, as a medical procedure. DW went to our Walgreens with receipts and names and phone numbers of Highmark's customer rep yesterday, and presented her case. Walgreen's tried for 30 minutes to rebill Highmark but all attempts were futile. Walgreens then called Highmark rep for assistance; and the that's when the SHTF! The Highmark rep told the Walgreens pharmacy department that as of 10/15/19, the Shingrix vaccine was no longer a covered expense.

DW stormed out and called Highmark as soon as she got home, and was on the phone with the rep's supervisor for over an hour, to no avail. The Highmark supervisor then gave DW a list of providers that did give the Shingrix vaccine in our area, and we explained that every provider on that list has no vaccine available on site and their waiting lists are over 200 patients long, were longer accepting names, for over 18 months. We are at a standstill but this fight is not over. DW is on this.

However, I have been vaccinated with the first dose, and it has cost me $150+ to get it.

Update on above issue with Highmark and Shingrix vaccine.


I received a $153 check today from Highmark; after DW wrote 1 letter and provided receipts. I have been made whole , however DW was not compensated for her hour of paperwork.