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Periodic Contributor

Re: Will Medicare Pay for Shingrix?

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Message 31 of 55

Well, yes, Part D plans are required to "cover" Shingrix. But, the copay for each of the two injections averages $150 (i.e., about $300 total) for the "covered" Shingrix vaccine. Of course, Medicare covers the huge hospital bill, if needed, if I get shingles and need hospitalization(can easily be thousands and thousands of dollars). I don't consider a $300 cost as "coverage." What's that saying about "an ounce of prevention is worth a pound of cure"?

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Periodic Contributor

Re: Will Medicare Pay for Shingrix?

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Message 32 of 55

In September 2018, The waiting lists at pharmacies was so long, no one would even put me on the waiting list for Shingrex.  I called the local Salt Lake County Health Department and they said I could sign up and they would call me on October 1, 2018 to set an appointment to get the shot.  When I arrived, they said they were not set up to deal with Medicare.  I decided to pay the $154 for the first shot and signed up for the second.  I have Uniited Health Care/AARP.  I submitted my receipt and the forms Optum sent me (their contracted processor).  I received a check from them in about one week for $102.00 reimbursement.  I can't speak for every Medadvantage plan, but United Health Care covered it less my deductable. 

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Re: Will Medicare Pay for Shingrix?

21,648 Views
Message 33 of 55

@michaele325563 wrote:

This is a totally rediculous situation. Everyone says focus on "Preventive Care". Medicare encourages you to shop for coverage, but nowhere, on their website or any other website can you simply find out which Part D plan covers the new shingles vaccine. Shouldn't that be a simple question?


For 2019, the majority of Part D plans should cover both shingles vaccines - with the newest, Shingrix,  being the best option.  

 

Shingrix should be be on their formulary - but if not, Medicare needs to know about it because they are suppose to cover (with a co-pay) all vaccines not covered by Medicare Part B.

 

Shingrix is a (2) part vaccine - with 2 - 6 months in between.  It is more effective than the old one - Zostavax.  It is recommended by the CDC for most everybody to get Shingrix even if you have Zostavax before.

 

As always, your primary care doctor should tell you if there is some reason for you not to get it.

 

Medicare Q1 FAQ - Do Medicare PartmD plans cover the shingles vaccine?

 

Just put it in the formulary search with any other meds you might take on a regular basis and see which plans come up with the best cost for you all the way around unless you have some other criteria to add to the mix in decision making.

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Periodic Contributor

Re: Will Medicare Pay for Shingrix?

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Message 34 of 55

I registered with Salt Lake County Health Department on the first part of October for the Shingrix vaccine.  In my area, it will be at least 2 to 8 months until Utah gets more vaccine according to the pharmacies I spoke with.  None would even let me sign up.  So, I registered with Salt Lake County Health Department on the first part of October for the Shingrix.  They called me the first week of November to make an appt. with me to get the shot.  When I arrived I was told that they could not bill medicare for anything besides flue and pneumonia vaccines.   I asked them to hold my shot until I could get more info from United Health Care.  I called customer service and after getting the runaround from a couple of agents, I called back.  This time I got Samantha.  She got me some answers.  She emailed a  from OPTUM Rx MAPD Reimbursement Request form.  She said I would have a copay depending whether my prescription deductible had been met.  I got my shot and a receipt for my Payment in full of $154 to Salt Lake County Health Department and added my name to the list of 101 people for the follow up shot.  I then went to my pharmacist who would not previously add me to the waiting list.  I found out that if I had gotten my shot, there, my copay would have been approximately $60.  I had decided I would get this shot and pay it myself if I had to.  So, now I will potentially be reimbutsed by UHC for $94.  I am glad I decided to spend the time investigating.

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Periodic Contributor

Re: Will Medicare Pay for Shingrix?

21,642 Views
Message 35 of 55

This is a totally rediculous situation. Everyone says focus on "Preventive Care". Medicare encourages you to shop for coverage, but nowhere, on their website or any other website can you simply find out which Part D plan covers the new shingles vaccine. Shouldn't that be a simple question?

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Periodic Contributor

Re: Will Medicare Pay for Shingrix?

22,791 Views
Message 36 of 55

Alas, both the 2018 & 2019 formularies were paper versions. Try calling United Healthcare they may be able to help you. I am in CA the formulary might be different in Utah. 

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Periodic Contributor

Re: Will Medicare Pay for Shingrix?

22,621 Views
Message 37 of 55

Will you give me the  link to your 2019 formulary?  I have United Health Care (AARP) and have been searchng for their 2019 formulary.  Utah has huge waiting lists and you cannot get added to them at this point.  The health department here has it in stock for $154 for each shot.  Like you, I had the original shot when it came out around 5 years ago.  It was not covered, but Utah State government had a deal where if the shot was not cmpletely covered by insurance, and if you were over 60, you could get it at local pharmies for $20.  I would appreciate your help.  No one at the pharmacy or health department has any decent info.  Thanks

 

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Periodic Contributor

Re: Will Medicare Pay for Shingrix?

16,295 Views
Message 38 of 55

Super!

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Periodic Contributor

Re: Will Medicare Pay for Shingrix?

12,331 Views
Message 39 of 55
We are in same boat. You just saved me $344 for the original and the follow up at Salt Lake Country Health Department.
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Periodic Contributor

Re: Will Medicare Pay for Shingrix?

15,198 Views
Message 40 of 55

i did some more research since my first comment. The clerk at CVS said I would be covered (she tried several different options), but the co-pay was very high. I tried Good RX & the lowest price I could find  was $150. Then I searched some more. I located this year's and next year's Formulary for my Part D plan. Shingrix is not in the 2018 Formulary, but is in the 2019. So since I already have the original Shingles vaccine I'll wait until 2019 to get Shingrix. Thanks for your response. 

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