Does Medicare Cover Shingrix?

Medicare Benefits Solutions
Jan 19, 2022

Shingles is a disease brought on by the varicella-zoster virus, the same virus that often afflicts children in the form of chickenpox. The medical term for shingles is herpes zoster. 

After you recover from chickenpox, the virus usually remains dormant. However, for about one in three adults, the varicella-zoster virus reactivates and causes shingles. Symptoms of shingles include painful rash, blisters, itchiness, numbness, fever and headache. Even after the symptoms go away, some people suffer from complications. 

Complications from shingles

The National Library of Medicine published an article about shingles complications, suggesting that virus reactivation is caused by “advancing age or immunosuppression.” Though there is no shingles cure to date, your doctor may prescribe medication to facilitate healing and lower your risk of complications. 

The most common complication of shingles is postherpetic neuralgia (PHN). PHN is a chronic nerve pain that continues after the blisters and rashes clear up. This residual condition mainly affects adults over age 60. Treatments can alleviate symptoms, but there is no cure for PHN.  

The Centers for Disease Control and Prevention (CDC) reports that the “shingles vaccination is the only way to protect against shingles and postherpetic neuralgia.” If you are looking for Medicare benefits to cover the cost of the vaccine, check your Part D prescription drug plan.

Medicare benefits for shingles vaccine

Part B Medicare benefits cover a few vaccines: flu, hepatitis B and pneumococcal shots. Part D Medicare benefits cover vaccines like shingles and DTaP (diphtheria, tetanus and pertussis).

Whether you have a Medicare Advantage plan that includes prescription drug coverage (MA-PD) or a stand-alone Medicare Prescription Drug Plan, you should have access to the plan’s formulary, the approved drug list. Search the tier of the formulary where the vaccine is listed. Generally, the higher the tier, the more the drug will cost. Your cost will vary depending on your plan.

CDC recommendations

Before Shingrix came on the market, Zostavax was the shingles vaccine used to prevent shingles. In 2020, Zostavax was discontinued in the United States. The CDC now recommends Shingrix (recombinant zoster vaccine) with these guidelines:

• Get two doses separated by two to six months if you are a healthy adult age 50 or older (no maximum age).
• Take the shot even if you had shingles, received Zostavax, or are uncertain if you had chickenpox.
• You don’t have to wait a specific amount of time after having shingles before you get the shot, but you should wait until the rash disappears.
• Don’t get the shot if you are allergic to any component of the recombinant zoster vaccine, currently have shingles, are pregnant or nursing a baby, or tested negative for virus immunity (in which case you should get the chickenpox vaccine).  

Resources

Here are a few resources to help you with your research about vaccines and treatments for shingles and related conditions:

• Centers for Disease Control and Prevention
• National Institute on Aging