Shingles is a condition caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. After a chickenpox infection, the virus can remain dormant in nerve cells for decades, potentially reactivating later in life to cause the painful rash and blistering associated with shingles. This condition can lead to severe discomfort and serious complications, such as postherpetic neuralgia (PHN), which is long-lasting nerve pain. The shingles vaccine serves to prevent the disease and its potential complications, offering important protection for public health, especially among aging populations.
Understanding Vaccine Costs
Shingrix is the recommended shingles vaccine. This vaccine is administered as a two-dose series, with the doses typically given between two and six months apart. For individuals paying out-of-pocket without any insurance coverage, the manufacturer’s list price for the full two-dose regimen is approximately $395.80, translating to about $197.90 per dose.
The actual cash price for a single dose can range from around $229.99 to $260.44, meaning the total cost for both doses could be around $500. This price can fluctuate based on several factors, including the specific pharmacy or clinic where the vaccine is obtained and the geographical location. It is important to remember that this represents the sticker price before any insurance benefits or discounts are applied.
Insurance Coverage Options
Most individuals with health insurance can expect to pay little to nothing out-of-pocket for the shingles vaccine. The specifics of coverage depend on the type of health insurance plan an individual has.
For those enrolled in Medicare, the shingles vaccine is covered under Medicare Part D, which includes prescription drug plans. As of 2023, thanks to the Inflation Reduction Act, beneficiaries with Medicare Part D pay $0 out-of-pocket for ACIP-recommended adult vaccines like Shingrix. It is advisable to confirm with a doctor’s office if they can bill Part D directly, as this is not always the case.
Private health insurance plans, including those purchased through the Affordable Care Act (ACA) Marketplace, are generally required to cover ACIP-recommended vaccines, such as Shingrix, without any cost-sharing. Approximately 96% of commercially insured individuals have coverage for Shingrix. For those with Medicaid, coverage for the shingles vaccine can vary by state. In states that have expanded their Medicaid programs under the ACA, Shingrix is often covered with minimal or no cost-sharing, sometimes less than $5 per dose.
Where to Get Vaccinated
The shingles vaccine is accessible through various healthcare providers. Many retail pharmacies, including large chains like CVS, Walgreens, and Safeway, offer the Shingrix vaccine.
Primary care physician’s offices are another common place to receive the vaccine. Additionally, some local health departments or community clinics may offer vaccination services. A prescription is generally not required to receive the shingles shot.
Saving on Vaccine Expenses
Even for those without comprehensive insurance coverage, several strategies exist to help reduce the cost of the shingles vaccine. One option involves exploring manufacturer patient assistance programs, such as the GSK Patient Assistance Program for Vaccines. These programs are designed to provide the vaccine at no cost to uninsured individuals who meet specific income and eligibility criteria.
Another way to potentially lower out-of-pocket expenses is by utilizing prescription discount cards or coupons from third-party programs like GoodRx, SingleCare, or ScriptSave WellRx. It is important to note that these discount options typically cannot be combined with health insurance benefits. Comparing prices across different pharmacies can also reveal variations in the cash price for the vaccine, allowing individuals to choose the most affordable option.