In honor of my Caught Dead in Wyoming mystery series, my assistant Kay Coyte is writing for my newsletter and blog a series of consumer tips inspired by TV reporter Elizabeth Danniher.
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Vaccines are in the news these days, mostly about parents refusing to vaccinate their children for measles. But there is a vaccine out there that patients are clamoring for – and can’t get. And when they can, they’re met with confusing messages on its cost and whether it’s covered by insurance.
The ailment you want to avoid is shingles, a painful, blistering skin rash caused by the same virus responsible for chickenpox. After a chickenpox outbreak (or, in rare cases, a chickenpox vaccination), the virus stays dormant in your body and later can reactivate, causing shingles. The risk of developing shingles increases with age. In addition to those painful blisters and flulike symptoms, about 20 percent of shingles sufferers develop lingering nerve pain that can be severe. Contemplation-of-suicide severe.
The Centers for Disease Control and Prevention (CDC) has approved two vaccines. The first was Zostavax, a one-shot treatment that begins to lose its effectiveness after five years, which is one reason why insurers wouldn’t cover it until patients reached the age of 60. The newer Shingrix, a two-shot regimen, is more effective, particularly in preventing nerve pain, and is recommended for those 50 and older.
But good luck finding Shingrix. Consumer Reports, AARP and NPR have reported on widespread shortages at both doctors’ offices and pharmacies. Many people who were lucky enough to get that first shot now are unable to secure a second one.
Manufacturer GlaxoSmithKline has a Shingrix locator that claims to be updated weekly. But when I plugged in my zip code, three nearby pharmacies did not have the vaccine. One had a waiting list of 85, the other 60 and counting. The CDC vaccine locator doesn’t designate Shingrix, though it has a general alert on the search. My physician’s office also saw no Shingrix on the horizon, possibly through 2019.
Should Shingrix, or the backup Zostavax, become available, it is expensive. Zostavax is about $250 without insurance. Out-of-pocket costs for the double dose of Shingrix have been reported from about $300 to $500. Under the Affordable Care Act (a k a Obamacare), private plans, whether employer-provided or bought on a state marketplace, are required to cover the cost of recommended vaccinations. With Medicare, it gets complicated. Unlike flu and pneumonia vaccines, fully covered as preventive services under Medicare Part B, shingles shots are covered as prescription drugs under Part D and Medicare Advantage plans. And, according to recent comments on a Consumer Reports alert titled “Why Does My Shingles Vaccine Cost So Much?“, both providers and insurers often give patients incorrect information about costs and coverage.
One suggestion, seconded by my doctor, is to get vaccinated at a pharmacy in your drug plan’s network. The pharmacy will bill your insurance company and you’ll pay the lowest out-of-pocket costs available under your plan.
Another tip: if your vaccination was misfiled, or the costs seem out of line, contact your Medicare broker to help advocate for you.
Final tip: If you’re desperate for shingles protection now, get a Zostavax shot. Then in three or four years, when Shingrix supplies should catch up with demand, you can build your immunity with Shingrix vaccinations. And do that while you still have non-Medicare insurance.