Why is the new shingles vaccine (Shingrix) so expensive for Part D of Medicare?

[Miguel 1952]

We seniors need this new shingles vaccine yet is very expensive with Part D prescription. I have SilverScripts and is $155 per vaccine and we must have two spread apart by several months.
Really disappointed as I really like Medicare with my supplemental and my Part D prescription.

[Stu from NYC]

We got it last year and didnt pay that much but was expensive.

Be that as it may I took the two shots and than about a month later got shingles.

Apparently my system was not fully protected and so got a very mild case.

If that was a mild case cannot imagine the pain and discomfort of a more severe case.

In any case as long as you can afford it strongly suggest you get the shots.

[OrangeBlossomBaby]

The cost without insurance ranges between $200 and $300. Medicare part D pays around half that. GoodRx will get you a shot for $155. That's for Shingrix specifically. If you want Zostravax it'd cost less, Medicare covers more, but it's less effective and you have to get it more often.

Shingrix is (theoretically) a one and done, once you have the appropriate two-dose vaccination in the right amount of time. But it will start to lose its effectiveness after 4 years, bringing it to "only" 85% effective (which is pretty impressive).

[gatherer47]

I just paid $45 through United Health Care Advantage plan

[OrangeBlossomBaby]

I just paid $45 through United Health Care Advantage plan

I paid nothing with my Connecticare, in February 2019. But that was in Connecticut. I don't know anything about coverage for Shingrix down here. Different plans offer different coverage. Connecticare was comprehensive.

[Stu from NYC]

The cost without insurance ranges between $200 and $300. Medicare part D pays around half that. GoodRx will get you a shot for $155. That's for Shingrix specifically. If you want Zostravax it'd cost less, Medicare covers more, but it's less effective and you have to get it more often.

Shingrix is (theoretically) a one and done, once you have the appropriate two-dose vaccination in the right amount of time. But it will start to lose its effectiveness after 4 years, bringing it to "only" 85% effective (which is pretty impressive).

New one on me that it will start to lose its effectiveness in 4 years. I would really not like to get shingles again.

[joeharing]

Humana advantage.
47.oo

[Singerlady]

Unfortunately, it all depends on your insurance. Mine was a $25 copay.

[riley2011]

We seniors need this new shingles vaccine yet is very expensive with Part D prescription. I have SilverScripts and is $155 per vaccine and we must have two spread apart by several months.
Really disappointed as I really like Medicare with my supplemental and my Part D prescription.

If you think that’s bad the doctor I go to is charging $2100 for a prolia shot (for osteoporosis).

[graciegirl]

CDC says new shingles vaccine is much more effective for older people. (read this)

I wonder if we called Publix and see if we can wait in the car in the parking lot until it is our turn to get the shot?

Shingrix vs Zostavax - What's the difference between them? (https://www.drugs.com/medical-answers/difference-between-zostavax-shingrix-3342576/)

[Tankerrich]

If you have Tricare For Life (Retired Military) and on Medicare, it's FREE. Got mine this year at Walgreens who takes TFL in Lauderdale by the Sea, FL

[oneclickplus]

Be that as it may I took the two shots and than about a month later got shingles..

Only a month later ... any thought that the vaccine may have caused your shingles episode?

[Nell57]

No charge for mine, but I’m probably paying a higher monthly premium for my part D than yours.
You might want to look at other plans and compare coverages during open enrollment periods this fall.,

[CWGUY]

If you think that’s bad the doctor I go to is charging $2100 for a prolia shot (for osteoporosis).

:) https://www.prolia.com/paying-for-prolia#ListPriceAnchor

[LG999]

The shots are expensive but they are worth every penny. We both had side effects for 1-2 days after. Very cold, exhausted. All joints & muscles hurt. We know ppl who got shingles & all this is worth not getting it to us.

[NotGolfer]

Addressing the getting shingles once you've had the shot....it's still possible to contract them, but I was told then the case may be more mild. Nonetheless, getting them is nasty from what I'm told.

[OrangeBlossomBaby]

New one on me that it will start to lose its effectiveness in 4 years. I would really not like to get shingles again.

It will still be effective. It'll just be only up to 85% effective, instead of over 95% effective.

[Eg_cruz]

We seniors need this new shingles vaccine yet is very expensive with Part D prescription. I have SilverScripts and is $155 per vaccine and we must have two spread apart by several months.
Really disappointed as I really like Medicare with my supplemental and my Part D prescription.
Why do you need the new one......did you not get the old one
If you got the original one why do you need an other.

[CWGUY]

Why do you need the new one......did you not get the old one
If you got the original one why do you need an other.

:ohdear: I would discuss that with my doctor. :oops:

[OrangeBlossomBaby]

CDC says new shingles vaccine is much more effective for older people. (read this)

I wonder if we called Publix and see if we can wait in the car in the parking lot until it is our turn to get the shot?

Shingrix vs Zostavax - What's the difference between them? (https://www.drugs.com/medical-answers/difference-between-zostavax-shingrix-3342576/)

At Publix the line to get to the pharmacy counter is marked by big green Publix dots on the floor, in 6-foot increments. Only one person at the counter at a time. Once you're processed through the very brief paperwork, you're asked to sit to the side in an area designated for that. There are only two chairs there, each facing a different direction, several feet apart (theory: if you're facing the opposite direction NEXT to the other person, it's very unlikely that germs can transmit from one to the other even if it's less than 6 feet away, since you're not breathing toward them at all).

Keep in mind though - just as an FYI: the Shingrix shot hurts a little going in - might or might hurt for the next hour - but that night it'll be VERY sore. Your entire arm. The first night is the worst. The second day is tolerable, the second night is still sore but 100% bearable. The third day you're usually fine again.

Once you get the shot, raise and lower your arm, shrug your shoulder, flex your fingers on that arm continually for the next hour. That'll reduce the ache.

[JonWilliams]

We seniors need this new shingles vaccine yet is very expensive with Part D prescription. I have SilverScripts and is $155 per vaccine and we must have two spread apart by several months.
Really disappointed as I really like Medicare with my supplemental and my Part D prescription.

If you ever get shingles, you'll happily pay a lot more than $155 to get rid of it.

[OrangeBlossomBaby]

Why do you need the new one......did you not get the old one
If you got the original one why do you need an other.

1. I'm not seeing in that person's post anything about having received the old one.
2. If he got the old one, he'd know that it wears off at some point and has to be done again.
3. If he's going to have to do it again (or do it for the very first time ever) then he might as well get the one that'll last the longest, with the best efficacy of the two.

[Corvettegal]

I just received the shots. Part 1 two months ago and Part 2 last week. My total cost for both shots was $84. I have Medicare BCBS PPO of MIchigan for my insurance. I do not know what insurance you have. It seems a little high cost for you. I would check into your insurance and see why it costs so much

[ruralgoddess]

I paid nothing for the vaccinations through my United Health Care policy.

[Villagesgal]

My medicare plan paid the entire thing, no out of pocket at all. Everyone has a different plan for different reasons. I have Plan F and love it. I pay more but for me it's worth it, no worries and piece of mind. I'd suggest you look at plans closely during open enrollment and possibly find a better one for you. $155.00 is cheap compared to getting shingles, a friend had it and was in agony for 4 weeks.

[Mike Shebel]

Please, contact Prolia directly and they will assist in payment, even with insurance. Most people don’t realize that.

If you have questions, speak with the office manager of the physicians office you go to. They have direct access to the manufacturers.

Hope this helps!

[Teachbeach]

I have had both Z (before Shingrix was manufactured) and then the 2 dose Shingrix shots. Insurance paid for all as it's considered preventative, even though given at Pharmacy. I would check w/ your supplemental, if you have one because mine was covered like the flu shot & pneumonia vaccine-

[DrHitch]

Yes, the 2-part Shingrex vaccine is fairly expensive. We are waiting until October to see if other prescription costs may cover our Medicare Part D deductable...then the Shingrex (at least the 2nd shot) should be covered or less costly....timing is 2 months apart.....it all depends on your particular part D plan

[Stu from NYC]

Only a month later ... any thought that the vaccine may have caused your shingles episode?

Not at all.

Several medical people I asked thought the logical explanation was my immunity via the vaccine was not fully in place yet. Also my family Dr whom I had the utmost faith in thought it might have been brewing in me before taking the vaccine.

Considering what my brother in law went thru in getting a full blown course of shingles I was kind of lucky.

[Scorpyo]

Yeah, you would think the shots should be covered 100% given that it should, in my opinion, be considered preventative medicine. I have Humana Advantage in GA. My portion was $153.83 at Walmart Pharmacy. I'm not complaining about the cost especially considering the alternative. I wonder how much more than the $153.83 it would have cost Humana had I contracted Shingles?

[MandoMan]

We seniors need this new shingles vaccine yet is very expensive with Part D prescription. I have SilverScripts and is $155 per vaccine and we must have two spread apart by several months.
Really disappointed as I really like Medicare with my supplemental and my Part D prescription.

Get the Shingrix two part vaccine, which is thought to be 89% to 95% effective against shingles, rather than the Zostavax, which is only about 50% effective. If you ever get shingles, you will definitely wish you had had the vaccine, whatever the cost.

I’ve had both, and I got them both for free (to me) due to the health insurance I had when employed. However, my health insurance was billed about $360 for the Shingrix vaccine two part combo. That’s a lot of money, but there are drugs used for treating shingles once you get it that cost a lot more than that!

Shingles is a herpes-based Disease, like chicken-pox. If you get the regular herpes people talk about, the antiviral drugs that can keep you from having attacks cost around $1,000 a month, I believe. If you are taking PReP to keep from getting HIV, I think that is also about $1,000 a month. If you have HIV and are taking drugs to stay alive, I believe that cocktail costs about $2,000 a month. I have two dear friends in Hobe Sound, Florida, in adjacent rooms, fighting for their lives right now to survive Covid-19. They have both had convalescent plasma antibodies—the man has had two doses. I have no idea what that costs, but I’d be very surprised if it was less than $5,000 a dose.

This is why the total cost of health care is so high. If my friends, age 91 and 85, with big health problems before catching Covid-19, are in the hospital under continuous, high-quality care for a month, whether or not they live, I’m sure they will have cost we the people a million dollars, even if they don’t have to pay much of it. Their Medicare Advantage plan will pay, and other people with that plan will then have to pay the premiums. This is how it works. And Medicare will pay, and all taxpayers pay for that. I’d rather pay my taxes than have shingles or herpes or HIV or Covid-19. I’m grateful for the excellent and seamless care my friends are receiving and the dedicated people helping them.

[CWGUY]

Yeah, you would think the shots should be covered 100% given that it should, in my opinion, be considered preventative medicine. I have Humana Advantage in GA. My portion was $153.83 at Walmart Pharmacy. I'm not complaining about the cost especially considering the alternative. I wonder how much more than the $153.83 it would have cost Humana had I contracted Shingles?

:shocked: We have a Humana Advantage Plan and the co-pay was $1 each shot. I guess they have a number of different plans???

[PugMom]

I paid nothing with my Connecticare, in February 2019. But that was in Connecticut. I don't know anything about coverage for Shingrix down here. Different plans offer different coverage. Connecticare was comprehensive.

my friends who had Connecticare RAVED about it-said it was better than BC/BS

[merrymini]

I was going to have the Shingrix shot but decided to call my insurance when I found out how much it cost. Then the china flu happened and they did not do any shots at Walgreens. I have very good coverage but it does not cover this shot according to Walgreen’s. It seems impossible to talk to anyone on the phone now but plan to take asap.

[Spike380]

I also only paid $45 for the 1st shot. Haven't had the 2nd one yet.

[kendi]

We paid nothing with UHC in Cincinnati.

[Skip]

When you say "I paid $1 or I paid nothing", you need to state which type you received: Shingrix or Zostavax. Both are available. They have different co-pays too.
For Tier 5 drugs you usually have a $395 deductible first then you pay 25% of the total cost after that deductible on an "Advantage Plan".
Skip

[Sheila Fisher]

What phase of your plan are you in?

[Snorkl46]

I got my first in 2019 and second in 2020. They both cost $28.50 at Walgreen's. The difference must be in the type of Part D that you have.

[dpmers]

I got both shots at Publix $40 ea, after my horrible bout with shingles I would have paid much much more to have avoided that experience. It's been 11 years since my bout and I still have occasional light pain

[Nealg]

We seniors need this new shingles vaccine yet is very expensive with Part D prescription. I have SilverScripts and is $155 per vaccine and we must have two spread apart by several months.
Really disappointed as I really like Medicare with my supplemental and my Part D prescription.
Read about the side effects carefully..

[rstebbins]

it’s more than likely your deductible depending on what other prescriptions you take. I only take tier 1 and 2 generic so none of the small costs get charged to the annual 435 (2020) deductible. So i had to pay the full cost of the shingles shots. On part D you are responsible for the first 435 in 2020

[YouNeverKnow]

If you think that’s bad the doctor I go to is charging $2100 for a prolia shot (for osteoporosis).
My Doctor charges 1800.00 plus 110.00 to give the shot (which takes all of 10 seconds and is given by the blood draw person in a lab.)
You have to get a shot every six months!

[Miguel 1952]

Why do you need the new one......did you not get the old one
If you got the original one why do you need an other.

I did get the old one in 2013. But Shingrix is 97% effective at preventing shingles. The Zostavax is between 50-64% at preventing shingles.

[bpascani]

I was wondering that as well.

[OrangeBlossomBaby]

my friends who had Connecticare RAVED about it-said it was better than BC/BS

It's awesome. The downside is that the coverage is only awesome if you're in Connecticut. If you move outside Connecticut and seek medical care in another state, you're out of network and not covered at all.

I believe if you go to a participating national pharmacy you're still covered for prescriptions and vaccines in other states though, which would be handy for snowbirders who haven't had their flu shot yet and get their shot at CVS in September in Florida.

[RVJim]

Why are we seniors always looking for something to be handed to us for free or reduced cost? We are the entitled generation, we take in more than we ever produced. We should be happy and grateful with what we get and not complain about having to pay for something. For god sakes, we live in The Villages, we live in a hermetically sealed world far away from everyday troubles. Paying a bit for a shingles vaccine is a trifle not to be worried about.

[OrangeBlossomBaby]

Why are we seniors always looking for something to be handed to us for free or reduced cost? We are the entitled generation, we take in more than we ever produced. We should be happy and grateful with what we get and not complain about having to pay for something. For god sakes, we live in The Villages, we live in a hermetically sealed world far away from everyday troubles. Paying a bit for a shingles vaccine is a trifle not to be worried about.

Generally - I tend to agree with you with regards to this particular issue.

However there are people living in the Villages on a fixed income, relying on Medicare, paying extra for prescription coverage, and then on top of that having to pay a couple hundred more dollars for a common, recommended vaccine that the prescription coverage doesn't cover.

Most of us can afford it. But not all of us can. Being retired doesn't mean being wealthy. Living in the Villages doesn't mean being wealthy. Some of us have to pick and choose where our money goes, and there isn't much left over at the end of the month.

[graciegirl]

Generally - I tend to agree with you with regards to this particular issue.

However there are people living in the Villages on a fixed income, relying on Medicare, paying extra for prescription coverage, and then on top of that having to pay a couple hundred more dollars for a common, recommended vaccine that the prescription coverage doesn't cover.

Most of us can afford it. But not all of us can. Being retired doesn't mean being wealthy. Living in the Villages doesn't mean being wealthy. Some of us have to pick and choose where our money goes, and there isn't much left over at the end of the month.

Some of those issues too rest on whether a person is sufficiently financially prepared to move to another state and stop working. We moved here in our late sixties. My husband worked remotely here until two years ago.

We have always been extremely careful and saving and financially conservative.

It is better to have extra when you need it, even if you do without or have to wait for good things to happen.

[La lamy]

I'm sorry you feel $310 (2 shots) for approximately a 5 year protection is expensive, but if you look it from another perspective, it's only 17 cents a day!

[Joanne19335]

We seniors need this new shingles vaccine yet is very expensive with Part D prescription. I have SilverScripts and is $155 per vaccine and we must have two spread apart by several months.
Really disappointed as I really like Medicare with my supplemental and my Part D prescription.

I got shingles before I knew what it was. I was 52 years old and living in Arizona. It was the worst experience of my life. I was unable to get a vaccine until I was 60 years old. I paid $300 and had to get the vial, put it on ice and go to my PCP and have it injected. Once I moved here, a new vaccine replaced the first as it was determined that the first one was not as effective and I could get reinfected. Fortunately, I paid nothing and had to get a booster in six months. I paid nothing for the booster. As a former pharmacy technician, I recall that most people were unable to receive the booster because of the demand and short supply. Once you pass the six-month period, you would have to get the first one again and wait another six months.

I am surprised that all Part D plans do not pay 100% for this important vaccine, but having had shingles once, I would pay anything they asked and not look back.

[Pedrocarrasco01@yahoo.com]

We seniors need this new shingles vaccine yet is very expensive with Part D prescription. I have SilverScripts and is $155 per vaccine and we must have two spread apart by several months.
Really disappointed as I really like Medicare with my supplemental and my Part D prescription.
We got the shingle vaccine in Boynton Beach, have Humana and we did not pay for it, it was included on our plan, that might have changed as it was 4 years ago!!!!!

[kendi]

When you say "I paid $1 or I paid nothing", you need to state which type you received: Shingrix or Zostavax. Both are available. They have different co-pays too.
For Tier 5 drugs you usually have a $395 deductible first then you pay 25% of the total cost after that deductible on an "Advantage Plan".
Skip

Shingrix. I cannot get a live vaccine. Received both injections and paid nothing. I was told by the pharmacist they don’t give the other much any more. We have UHC with annual deductible, not on Medicare yet.

[Skip]

Shingrix. I cannot get a live vaccine. Received both injections and paid nothing. I was told by the pharmacist they don’t give the other much any more. We have UHC with annual deductible, not on Medicare yet.
That's the difference. You or your employer are paying premiums for non-Medicare (better )coverage.
Skip...

[Stu from NYC]

Yeah, you would think the shots should be covered 100% given that it should, in my opinion, be considered preventative medicine. I have Humana Advantage in GA. My portion was $153.83 at Walmart Pharmacy. I'm not complaining about the cost especially considering the alternative. I wonder how much more than the $153.83 it would have cost Humana had I contracted Shingles?

We had a Humana Advantage plan in Va and if I remember correctly each shot was about $ 90 each.

When we thought I had contracted shingles after the vaccinations my nurse sister pushed me to go to a local emergency room for treatment.

The nurse practitioner who saw me first decided it was a bug bite but asked him if there was a more senior physician there would could give me a second opinion.

He walked in and 15 seconds later said you have shingles and gave the NP a bit of a lesson on diagnosing shingles.

Gave me prescription for an antiviral. Bill for emergency room was somewhere about $ 1500 and Humana brought it down to about $ 500 and we paid about $ 100. Money well spent by us.

Apparently the Humana Gold plan sold here in Florida would give much better coverage at a cheaper price for all kinds of things medical.

[bjd0105]

I am a pharmacy technician and I have suggested to my patients that have a high copay to call their insurance. Ask them if they can lower the copay and some have done it. It doesn't hurt to ask.

[Stu from NYC]

Why are we seniors always looking for something to be handed to us for free or reduced cost? We are the entitled generation, we take in more than we ever produced. We should be happy and grateful with what we get and not complain about having to pay for something. For god sakes, we live in The Villages, we live in a hermetically sealed world far away from everyday troubles. Paying a bit for a shingles vaccine is a trifle not to be worried about.

I do not see it that way. Why not get the biggest bang for your buck?

[New Adventures]

[QUOTE=Miguel 1952;1818565]We seniors need this new shingles vaccine yet is very expensive with Part D prescription. I have SilverScripts and is $155 per vaccine and we must have two spread apart by several months.
Really disappointed as I really like Medicare with my supplemental and my Part D prescription.[/QUO

I got mine at CVS in Wildwood for $20. My doctor's always suggest that I get this shot from a pharmacy as it is much cheaper. I have BC/BS Medicare coverage.

[OrangeBlossomBaby]

Some of those issues too rest on whether a person is sufficiently financially prepared to move to another state and stop working. We moved here in our late sixties. My husband worked remotely here until two years ago.

We have always been extremely careful and saving and financially conservative.

It is better to have extra when you need it, even if you do without or have to wait for good things to happen.

Yes, we had extra for when we needed it. And then - we needed it. Now we don't have that extra anymore, because we needed it.

That's how "for when you need it" works.

[Stu from NYC]

Yes, we had extra for when we needed it. And then - we needed it. Now we don't have that extra anymore, because we needed it.

That's how "for when you need it" works.

Very true

[Galesmom]

Just today I found out that Shingrix is paid by your Medicare D plan! You pay whatever the copay if you have a Medicare Advantage Plan. So I just got the shot on Saturday and because I had not yet made my deductible, it cost me $179. I found out if I had gone to a place that accepts Humana (where I have my D plan) it would have cost me $126. So live and learn! This was the first shot. I will try to get the next one at Walmart Neighborhood.

[Aacosner]

Keep in mind though - just as an FYI: the Shingrix shot hurts a little going in - might or might hurt for the next hour - but that night it'll be VERY sore. Your entire arm. The first night is the worst. The second day is tolerable, the second night is still sore but 100% bearable. The third day you're usually fine again.

Once you get the shot, raise and lower your arm, shrug your shoulder, flex your fingers on that arm continually for the next hour. That'll reduce the ache.

This bit about the pain is spot on. I had my first shot a couple of days ago, and am just now getting over it. I wish I had seen the part about reducing ache -- I'll try that when I get the second shot in a few months.