Shingles Vaccine Medicare Copay



Medicare beneficiaries who are able to get their hands on a dose of the new shingles vaccine, which has been in short supply, may pay more than they expect. The lowest GoodRx price for the Shingrix vaccine is about $151. This is the cost of the medication only and does not include administration fees. Shingrix is covered by most health insurance and Medicare Part D, though there may be a copay. What’s the difference between Shingrix and Zostavax? But the shingles vaccine is covered under the Part D prescription drug program. That means you must be enrolled in a private Part D plan (a stand-alone drug plan or a Medicare health plan that covers drugs), get the vaccine through your plan and pay whatever share of the cost that your plan requires. Here’s the quick answer. Surprisingly, Original Medicare (Parts A and B) doesn’t cover the shingles vaccine, even though it covers other vaccines like the flu vaccine and pneumonia shot. On the other hand, Medicare Part D—or a Medicare Advantage plan that includes Part D coverage—typically does cover the vaccine. The devil is in the details.

Covered Services

Learn more about what we cover -
including health, dental, and pharmacy.

TRICARE covers the shingles vaccine for age appropriate beneficiaries. You can get the vaccine at a participating TRICARE network pharmacy or at your doctor’s office.

Getting Vaccines at TRICARE Network Pharmacies

You can get the shingles vaccine for free at a participating network pharmacy. You can find a pharmacy by:

Shingles Vaccine Medicare Copay
  • Calling 1-877-363-1303
  • Using the Express Scripts Mobile App
Shingles

Getting Vaccines from Your Doctor’s Office

If you want to get the shingles vaccine at your doctor’s office, find out how below.

If you're using:You can get the shingles vaccines from: You'll pay:
  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Young Adult-Prime
  • US Family Health Plan
  • Your primary care manager or any network provider
  • Referral or authorization not required
$0
  • TRICARE Select
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE Young Adult-Select
  • TRICARE Select Overseas
  • Any TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS(network or non-network)
  • Vaccine must be given in the doctor's office.
$0
  • TRICARE For Life
  • Any TRICARE-authorized provider (network or non-network)
  • Vaccine must be given in the doctor's office.

TRICARE's deductible and cost-shareA percentage of the total cost of a covered health care service that you pay..

Ssh authorized key. Note: If you get the vaccine from your provider, you may have to pay copayments or cost-shares for the office visit or other services received during the office visit.

TRICARE coverage for vaccines is based on recommendations from the Centers for Disease Control and Prevention (CDC). Visit the CDC website to learn more.

This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.

Shingles

Last Updated 6/18/2020

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Shingrix (zoster vaccine, inactivated) is a member of the viral vaccines drug class and is commonly used for Herpes Zoster - Prophylaxis.

Why is shingles vaccine not covered by medicareShingles Vaccine Medicare Copay

Shingrix Prices

The cost for Shingrix intramuscular powder for injection adjuvanted is around $179 for a supply of 1 powder for injection, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

This Shingrix price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.

Intramuscular Powder For Injection

adjuvantedShingrix intramuscular powder for injection
QuantityPer unitPrice
1$178.64$178.64
10$170.09$1,700.88

Important: When there is a range of pricing, consumers should normally expect to pay the lower price. However, due to stock shortages and other unknown variables we cannot provide any guarantee.

Drugs.com Printable Discount Card

The free Drugs.com Discount Card works like a coupon and can save you up to 80% or more off the cost of prescription medicines, over-the-counter drugs and pet prescriptions.

Print Free Discount Card

Shingles Vaccine Medicare Copay Assistance

Please note: This is a drug discount program, not an insurance plan. Valid at all major chains including Walgreens, CVS Pharmacy, Target, WalMart Pharmacy, Duane Reade and 65,000 pharmacies nationwide.

Shingrix Coupons and Rebates

Shingrix offers may be in the form of a printable coupon, rebate, savings card, trial offer, or free samples. Some offers may be printed right from a website, others require registration, completing a questionnaire, or obtaining a sample from the doctor's office.

There are currently no Manufacturer Promotions that we know about for this drug.

Patient Assistance Programs for Shingrix

Patient assistance programs (PAPs) are usually sponsored by pharmaceutical companies and provide free or discounted medicines to low income or uninsured and under-insured people who meet specific guidelines. Eligibility requirements vary for each program.

Provider: GSK Patient Assistance Program

Elligibility requirements:
  1. Must be uninsured
  2. At or below 250% of FPL
  3. Not required
  4. The patient must live in one of the 50 states, the District of Columbia, or Puerto Rico* and utilize the US healthcare system
  5. Patients may apply on their own or with the help of an advocate. Fax or mail enrollment documents to the program with patient name and date of birth on each page (faxed prescriptions are only valid if faxed directly from a prescriber's office). Eligible patients may receive 90 day supply of medicine to their home within 7 days of faxed enrollment (mailed enrollments may take longer to receive medicine). If enrollment documents are submitted by mail, submit ONLY COPIES of Proof of Household Income documents. Do not mail original income or tax documents. Documents submitted cannot be returned. Prescriber must register for the Vaccines patient assistance program only. Enroll online at GSKPatientAssistanceProgramPortal.com. *Puerto Rico Residents do not qualify for vaccine products.
Applicable drugs:
  • Shingrix (zoster vaccine recombinant) Injection

Shingles Vaccine Medicare Copay Cards

More information please phone: 866-728-4368Visit Website

More about Shingrix (zoster vaccine, inactivated)

Consumer resources

Does Medicare Pay For Shingles Vaccines

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Does Medicare Pay For Shingles Shots 2020

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