Does Medicare Cover the Shingles Vaccine in Decatur, IL?

Shingles (herpes zoster), a painful rash due to a reactivation of the chickenpox virus, is most common after age 50. There is a vaccine, called Shingrix, that can prevent shingles as well as complications caused by it like vision loss and pneumonia.  

The CDC recommends everyone over age 50 get the two-part shingles vaccine, but how does it work? And does Medicare cover Shingrix?

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Why Should I Care About Shingles Anyway?

After you recover from chickenpox, its virus – called Varicella – lies dormant in your nerve cells.

After many decades of your immune system getting weaker, the virus can come back to life in the form of a painful, blistering rash typically on the torso (though it can appear anywhere on your body).

Shingles is very common, and your risk increases as you age. According to Shingrix, you have a 33% chance of getting shingles.

Shingles is a painful rash that blisters and scabs over for about a week. Almost all people who get shingles experience acute pain. Many sufferers report the pain as feeling “stabbing, burning, or shock-like.”

While the weeklong pain is enough to make you want the vaccine, the most common complication, postherpetic neuralgia (PHN), is severe pain that lasts for months – sometimes years – where the rash used to be.

If the rash is around your eye, it can lead to vision loss, and partial weakness and paralysis can occur where your nerves were affected.

Shingrix, the first FDA-approved shingles vaccine in over 10 years, can reduce your risk of getting shingles by over 90%.

Shingrix, the Shingles Vaccine

The Shingrix vaccine is two doses in your upper arm. The shots are separated by 2-6 months (CDC). The CDC also explains it’s a very effective vaccine:

“Two doses of Shingrix is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated.”

Currently, the shingles vaccine is the only way to protect against shingles along with its complications. If you’re over age 50, the CDC recommends you get vaccinated.  

Even if you’ve never had the chicken pox, you should still get the vaccine.  

Zostavax vs. Shingrix

The CDC says you should get Shingrix, even if you’ve received Zostavax in the past. Both are shingles vaccines, but how are they different?

As of November 18, 2020, Zostavax is no longer available for use in the United States.  

Shingrix is an inactivated vaccine while Zostavax was a live vaccine. In other words, Zostavax contained a weakened version of the actual virus. Researchers found Zostavax could cause an infection, and it wasn’t a great option for those who are immunocompromised.

Also, Shingrix is over 90% effective, while Zostavax was only 51% effective (Clinical Trial out of San Diego).

Bottom line: Shingrix is the shingles vaccine your doctor will recommend, even if you’ve had Zostavax in the past.

Where Can I Get Shingrix In Decatur, IL?

You can get the Shingrix vaccine in your doctor’s office or a pharmacy.  

According to Shingrix’ vaccine locator, the following locations in Decatur, IL have the Shingrix vaccine, though you should call ahead to make sure they have it in stock:

• CVS Target
• Walgreens
• Walmart
• Colees Corner Drugs
• Kroger Pharmacy
• Dales Southlake Pharmacy
• St. Mary’s

Medicare Coverage for Shingles Vaccine

Original Medicare, or your Part A and B coverage, doesn’t cover the shingles shot. However, most Part D drug plans do.  

Here in Decatur, IL, many of the most popular drug plans – such as SilverScript and Mutual of Omaha – offer some coverage for the Shingrix vaccine, though it’s not free.

Under most drug plans, Shingrix is considered a Tier 3 drug. For reference, generics are Tier 1, while Tier 3 includes non-preferred, brand name drugs.

We checked several popular drug plans in Decatur, IL and the cost for one dose of the Shingrix vaccine at a preferred, in-network pharmacy is about $178 (varies by plan). The “retail” cost for Shingrix is $280, so you do enjoy some savings with your Part D drug plan.

Note: The same concepts apply for those with a Medicare Advantage Prescription Drug plan (MAPD). The drug coverage part of your Advantage plan works just like a Part D plan.

You need two doses, so your total cost for the Shingrix vaccine would be around $356. While it does seem expensive, Patty Gogerty in our office says it’s well worth it:

“If you’ve known of anyone that has gotten shingles, it is very painful. I have a client who thought he had poison ivy on his face, and it started to go into his eye. It turns out it was shingles, and he almost lost his eyesight. He is still taking medication for it, and that was 2 years ago.”

Check GoodRx

If you don’t have prescription drug coverage – or you want to compare prices – check out GoodRx. GoodRx is a free service that allows you to compare medication costs to find the best price in your area. Sometimes, GoodRx has cheaper prices than what you pay with your drug plan.

Our search in Decatur, IL found you can get the Shingrix vaccine from Target or Walgreens for $155 (with a coupon).

Michael Sams in our office says you do need to be aware of one detail: you can’t use GoodRx in addition to your insurance.

“You’ll need to go to a different pharmacy to utilize GoodRx pricing,” he explains. “For example, if you usually go to Walgreens, and they have your Part D plan information, you’ll want to go to Target and tell them you’re paying out-of-pocket.”  

Patty says one thing to consider is your drug plan’s deductible. You may get a slightly cheaper price through GoodRx, but if you buy the vaccine through your drug plan, it counts towards your deductible. If you reach your deductible in the year, your other prescriptions will cost a lot less.

Conclusion

Your Medicare Part D drug plan will help cover the cost of the Shingrix vaccine, though it is still a bit pricey. You may be able to save a few dollars by utilizing GoodRx, but keep in mind the drug cost won’t count toward your plan’s deductible.

In any case, our agents recommend getting the shingles vaccine, despite the price tag.

If you have any questions about your drug plan’s coverage of Shingrix, call us at 217-423-8000 and our licensed agents will be happy to help!