Medicare Part D prescription drug plans do cover the shingles vaccine (stand-alone Medicare Part D plans and Medicare Advantage plans that include drug coverage). And, beginning January 1, 2023, the 2022 Inflation Reduction Act
stipulates that Medicare Part D beneficiaries will have no cost sharing for vaccines
that are recommended by the Advisory Committee on Immunization Practices
), such as Shingles and Pneumonia vaccines.
Coverage of the Shingrix® vaccine -- Update May 1, 2018:
Please note, the new shingles vaccine Shingrix
® (approved by the FDA in October, 2017), is now available on most Medicare Part D plans and Medicare Advantage plans that include drug coverage.
Review plans that cover Shingrix
® in our Drug Finder
(see below for an example search result).
In January 2018, the CDC released the statement:
"CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine called Shingrix®, separated by 2 to 6 months, to prevent shingles and the complications from the disease. Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.
provides strong protection against shingles and postherpetic neuralgia (PHN). 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. Shingrix is the preferred vaccine, over Zostavax®, a shingles vaccine in use since 2006."
If Shingrix® is not on your Medicare Part D plan drug lists
(formularies), please speak with your Medicare Part D plan's
Member Services department and ask when the plan will be adding Shingrix®
to their formulary.
You can also ask your Medicare Part D plan about a Formulary Exception
whereby the plan would provide coverage for a non-formulary drug. You can click on the following link to learn more about Formulary Exceptions and the appeals process should your plan deny your Formulary Exception request:
Coverage of the Zostavax® vaccine
As reference, the shingles vaccine, Zostavax® was approved in May 2006
by the U.S. Food and Drug Administration (FDA) as a vaccine for use in
adults ages 60 and over who have had chickenpox.
is currently not covered by any Medicare Part D plans.
In the past, Zostavax®
was treated as a Tier 3 or Tier 4 medication and in some cases required
prior authorization or step therapy. You can click here to see how Zostavax was covered by 2019
Medicare Part D plans.
Additional medications listed as treatments for Shingles are:
Seeing whether your plan covers the shingles vaccine (using Shingrix® example)
Valtrex® (generally a Medicare Part D Tier 3 medication, covered by very few plans) and
Protopic® (generally a Medicare Part D Tier 4 medication, covered by very few plans)
You can see the coverage for Shingrix® (or any other this
medication in your area) by using our Medicare Part D Drug Finder (Q1Rx.com
Just select your state of residence, enter the drug name such as
"Shingrix" (or other drug name - or partial drug name), and
click on the green "Search" key.
If your chosen medication has multiple strengths or forms, you can
choose the correct dosage or delivery form and click "Search" again.
You should see the results of the plans covering your chosen drug and
the cost of coverage - and the estimated average retail price, when
New Drug Code starting in 2020 - Same Shingrix vaccine
You will notice in this graphic that the National Drug Code (NDC
uniquely identifying the Shingrix vaccine was "58160081912". However,
in 2020 the NDC for Shingrix changed to "58160082311" (same drug, just
with a different identification code). As reference, here is a link to Shingrix coverage in 2019
and this coverage can be compared to the 2020
and 2021 coverage of Shingrix with the new NDC
Medicare Part A and Medicare Part B does not cover Shingles Vaccine.
Please note, Medicare Part B (out-patient care) does not cover the shingles vaccine
but you can have your doctor administer the vaccine in their office
Your doctor probably cannot charge your Medicare Part D plan for the
vaccine, so you can pay your doctor out of pocket, and then ask your
Medicare Part D plan to reimburse you for the cost of the vaccine.
As noted by Medicare: "Shingles shot - How often is it covered?
The shingles shot isn’t covered by Medicare Part A (Hospital Insurance)
or Medicare Part B (Medical Insurance). Generally, Medicare prescription
drug plans (Part D) cover all commercially-available vaccines (like the
shingles shot) needed to prevent illness. Contact your Medicare drug
plan for more information about coverage."
For more information, please see our FAQ:
"Can the co-pays for the shingles vaccine (Zostavax) vary by the pharmacy where purchased and administered?
Please remember: We are not physicians, nor are we pharmacists. The
above information is strictly for informational purposes. Please consult
your doctor or pharmacist when determining treatments.