Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community

Do Medicare Part D plans cover the shingles vaccine?

Category: Q&A of the Day

Yes.  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).  However, coverage (and cost) of the vaccine can vary depending on your chosen Medicare prescription drug plan, vaccine, and the pharmacy where you have the vaccine administered.

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.

Shingrix 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."
(source: https://www.cdc.gov/ vaccines/vpd/ shingles/public/ shingrix/index.html)

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:  https://q1medicare.com/ PartD-DrugListExceptionAppealGrievance.php

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.

Zostavax® is covered by most Medicare Part D plans, however Zostavax® can be treated differently depending on the plan.

In most cases Zostavax® is treated as a Tier 3 or Tier 4 medication and in some cases requires prior authorization or falls into the step therapy program.  Please check with your specific Medicare Part D plan to determine the handling of Zostavax®.

Related Information: 

Additional medications listed as treatments for Shingles are:
  • 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)
Seeing whether your plan covers the shingles vaccine (using Shingrix® example)

You can see the coverage for Shingrix® or Zostavax® (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 Zostavax" (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 available.

Q1Rx.com Shingrix chart

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 D Coverage of Zostavax®

You can click on the following the link to see how Zostavax® is covered by stand-alone Medicare Part D plans in Florida: https:/Q1Rx.com/FL/00006496341.  You can click here to see how Zostavax was covered by 2019 Medicare Part D plans.

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."

(https://www.medicare.gov/coverage/ shingles-vaccine.html)

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.

Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs

Browse FAQ Categories

Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.

  • No enrollment fee and no limits on usage
  • Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.

Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.