New Shingrx Shingles Vaccine

[Huston55]

Have confirmed with GP & primary pharmacy (which gives it) that it’s recommended, available & covered. Plan to get it shortly. FYI, had the older shingles vaccination in the past.

 

[Dtail]

Will be checking it out with GP within 2 months. Some scary shingles stories posted here.

 

[gauss]

Have confirmed with GP & primary pharmacy (which gives it) that it’s recommended, available & covered. Plan to get it shortly. FYI, had the older shingles vaccination in the past.

Interesting.

I can see GP and pharmacy speaking to the recommended and available issues, but can they speak to insurance coverage? Doesn't your insurance company determine that?

-gauss

 

[Huston55]

Interesting.

I can see GP and pharmacy speaking to the recommended and available issues, but can they speak to insurance coverage? Doesn't your insurance company determine that?

-gauss

I asked my pharmacist, who knows our insurance, if it’s covered & he said yes. But, technically, you’re correct; I need to confirm with insurance to know for sure.

 

[wmc1000]

Omni550 - typically vaccinations are covered under Part D RX and not Part G Supplement. Aetna has both, my wife has Aetna Plan G and also Aetna Part D plans.

 

[Dreamer]

I am covered under FEP Blue Cross/Blue Shield and called them last week to see if they cover the new vaccine. She told me that they do not cover it yet. They did cover the older shingles vaccine for me when I was in my 50's. I did get Shingles after receiving the vaccine, but had a very mild case. I plan on getting the new vaccine as soon as insurance covers it.

 

[zinger1457]

I asked my pharmacist, who knows our insurance, if it’s covered & he said yes. But, technically, you’re correct; I need to confirm with insurance to know for sure.

I would definitely check with the insurance company. When I asked my doctor for the old shingles vaccine a few years ago he insisted it wasn't covered and that I would have to pay the OOP cost but I had confirmed it was covered beforehand with my insurance company. I checked my BCBS-AZ plan documents and it states that the shingles vaccine is covered as preventative but with a side not stating that it only requires one dose so that makes me wonder if the new vaccine is also covered. I've contacted BCBS for clarification.

 

[Done]

Hmm - Wouldn't you pay 100% of the cost until your deductible of your HDHP is met (especially if they are calling it medical)?

My experience is the only things that evade the deductible are things classified as screening/prevantitive.

They consider listed immunizations to be preventative, along with an annual exam, occasional screening colonoscopy, etc. The plan covers these at 100% with no deductible.

 

[testing321]

I have the Humana Medicare Part D Walmart prescription coverage, and I just checked their website and Shingrix is now covered as a tier 4 drug. Since I am still in the deductable phase, it says my cost is $140.23. I presume that I would pay this twice. Wifey has employer provided coverage through Cigna, and it appears to be covered as well under preventative (no cost, lucky her).

 

[CaptTom]

Called my insurer (Cigna) and the person had never heard of Shingrx, or even that there was a "new" shingles vaccine. She checked with someone else, and here's the interesting part:

She said to tell the provider to use the same procedure code as the old shot, and they'll cover it. I asked if there was anything special needed, since it's a course of two shots instead of one. She checked and said no, just enter the same code twice.

CVS/Walgreens said the can do the shot on a walk-in basis, handle the insurance and don't need a doctor's prescription.

YMMV, but it looks like I'll be getting a shot soon.

 

[testing321]

Called my insurer (Cigna) and the person had never heard of Shingrx, or even that there was a "new" shingles vaccine. She checked with someone else, and here's the interesting part:

She said to tell the provider to use the same procedure code as the old shot, and they'll cover it. I asked if there was anything special needed, since it's a course of two shots instead of one. She checked and said no, just enter the same code twice.

The procedure code for Shingrix is 90750. I did online chat and they said it was covered.

 

[gauss]

She said to tell the provider to use the same procedure code as the old shot, and they'll cover it. I asked if there was anything special needed, since it's a course of two shots instead of one. She checked and said no, just enter the same code twice.

Hmmm... Reading between the lines, it sounds to me like she was itching to get off the telephone with you.

Perhaps a follow up call will result in another agent picking up will either confirm or contradict the conclusions given in the first call.

-gauss

 

[Goonie]

BCBS Illinois covered mine yesterday, no copay.

That's great to hear since I have BCBSIL also. I'll be going to get it in the near future, but I'm going to wait for a little while after my next scheduled blood donation in a few days.

 

[littleb]

Blue Cross & Blue Shield of Tennessee covers the new shot age 50 and above. Either at in network dr or in network pharmacy. I suggest everyone call their insurance company before getting the shot.

Edited: My dr office nor local pharmacy have the vaccine yet and do not have an estimated date.

 

[CaptTom]

Hmmm... Reading between the lines, it sounds to me like she was itching to get off the telephone with you.

She actually didn't seem that way. She seemed genuinely curious, and twice put me on hold to ask someone else.

 

[redduck]

Hmmm... Reading between the lines, it sounds to me like she was itching to get off the telephone with you.

Perhaps a follow up call will result in another agent picking up will either confirm or contradict the conclusions given in the first call.

-gauss

She actually didn't seem that way. She seemed genuinely curious, and twice put me on hold to ask someone else.

It still might be prudent to call again.

 

[Dare]

Just called United Health Care (MN/WI) and they're not covering it yet. No info on when it might become covered. The person I spoke to actually made it sound like UHC is still deciding whether or not to cover it, but I have to think they will and it's just a matter of time.

Darn, I wanted to get it over with. My doctor finally has it available too. I might just pay for it myself, although the doctor's office said it was "really expensive". They couldn't give me an actual price, so I'm hoping it's in the $200-$300 range I've heard about and not thousands of dollars without insurance coverage. Hopefully when I make the appointment they can give me the specific price.

 

[flintnational]

GoodRX shows the cost at $294 without insurance. It says 1 vial. So I dont know if this covers both shots or just the first shot.

 

[omni550]

I just called my Medicare Part D insurance. They do not cover Shingrx.

I then called my Medicare Supplemental Part G insurance. They said they cover everything (at 20%) that Medicare covers (at 80%)....and then they transferred me to Medicare.

Medicare said they don't cover Shingrx.

omni

 

[wmc1000]

Since the Medicare drug formularies probably don't get updated much if at all between the open enrollment period each year it may take until the middle of the year or it might not change until 2019.

 

[ocdokie]

Darn, I wanted to get it over with. My doctor finally has it available too. I might just pay for it myself, although the doctor's office said it was "really expensive". They couldn't give me an actual price, so I'm hoping it's in the $200-$300 range I've heard about and not thousands of dollars without insurance coverage. Hopefully when I make the appointment they can give me the specific price.

My insurance does not cover Shingrix. I got my first Shingrix shot last month at Costco for a cash price of $156.00. The second shot is due within 6 months of the first; it will also cost $156.00, so the total will be a little over your $300 upper range. I think it's worth it.

 

[zinger1457]

BCBS-AZ responded back to my question stating that Shingrix is covered.

 

[Gallaher]

A completely different different perspective here.
I had a very minor shingles outbreak in my late 40’s. Ouch!!!

I was too happy to pay the full cash price for the new vaccine.
A bargain at twice the price!

 

[nwsteve]

I have the Humana Medicare Part D Walmart prescription coverage, and I just checked their website and Shingrix is now covered as a tier 4 drug. Since I am still in the deductable phase, it says my cost is $140.23. I presume that I would pay this twice. Wifey has employer provided coverage through Cigna, and it appears to be covered as well under preventative (no cost, lucky her).

+1. I was running errands in our local WM today and noticed no one at the pharmacy so went over to check on my coverage under Humana's Wallmart Part D coverage. They did have the vaccine and it was "covered"--with a $160 copay! Total cost is $167.
So yes you can get the Shingrix shot but the CDC's as a necessary recommendation apparently has not worked it's way into Humana as of today.

 

[testing321]

+1. I was running errands in our local WM today and noticed no one at the pharmacy so went over to check on my coverage under Humana's Wallmart Part D coverage. They did have the vaccine and it was "covered"--with a $160 copay! Total cost is $167.
So yes you can get the Shingrix shot but the CDC's as a necessary recommendation apparently has not worked it's way into Humana as of today.

I ended up paying the same thing under that plan. The EoB shows

Fill date & Rx ID Drug name Pharmacy Tier Stage(s) You paid Humana paid
February 07, 2018 SHINGRIX VIAL KIT WALMART PHARMACY 4 1 $160.23 $0.00

So its in the system as a tier 4 drug and I paid $160.23 because I haven't met the deductible. Had I met the deductible, I would have paid 35% of the $160 for Tier 4.