Anthem Blue Cross Adds Shingles Vaccine to Pharmacy Coverage

Shingles rash. Yep, looks like what I had.

doctor holding an injection

Updated blog post on pricing for Zostavax: Shingles Vaccine Price Varies from Pharmacy and Health Plan, August, 2013

Anthem Blue Cross has added the brand-name vaccine Zostavax for the immunization against the shingles virus to its drug formulary in California. This won’t lessen the cost of approximately $160 for the one-time injection for those members with a “Generic” only prescription drug benefit. Other plans may have a pharmacy deductible that must be met before “Brand Name” drugs become eligible for the reasonable copayment price.

You can review your Evidence of Coverage for your specific health plan to see how the prescription drug benefit works. There are some rebate programs and discounts on-line for Zovatax that might help reduce the price. Just be careful that you are not signing up for some prescription drug discount card that charges you a non-refundable application or monthly fee.

That’s what I got!

Shingles rash. Yep, looks like what I had.

Shingles rash. Yep, looks like what I had.

After reviewing the symptoms, looking at the pictures of the shingles rash, and knowing I had chicken pox when I was kid, I now know that I have been having outbreaks of the shingles on my legs these past couple of years. So guess who is going in for the shingles vaccine? See you at the pharmacy when we get our shots!

Full press release from Anthem Blue Cross

Shingles vaccine now covered at pharmacy

January 29, 2013

On January 1, 2013, we began pharmacy coverage of the brand-name vaccine, Zostavax. This is a one-time-only adult immunization against the shingles virus. At this time, there is no generic alternative for Zostavax.

Because the shingles vaccine needs special handling, many doctors have stopped making it available in their offices, making it harder for members who want to get the immunization.

Where should members get their one-time-only shingles immunization?

  • Older adult members can get the shingles vaccine at a participating network pharmacy.
  • Many major pharmacy chains, such as CVS, Rite Aid and Walgreens, take part in the shingles immunization program. We encourage people to call the pharmacy first, to make sure it is in the shingles vaccine program and has the serum in stock. They might also want to confirm whether a doctor’s prescription is needed to get the vaccine, as this may vary.
  • Members also may get their shingles vaccine through their doctor, if he or she stocks the serum in the office.
  • If the doctor doesn’t stock the vaccine in the office, he likely will refer patients to a pharmacy for their shot.

How is the benefit paid?  
All prescription drug plans, except generic-drug-only plans (there is no generic for Zostavax), include this now. However, benefits will vary from plan to plan, based on whether the plan is “grandfathered,” meaning that it does not include the preventive care provisions of the Patient Protection and Affordable Care Act (PPACA).

  • Members on a non-grandfathered plan will not need to pay a cost share.
  • Members on a grandfathered plan – one that did not implement the PPACA preventive care provisions –may pay a cost share based on their benefit design.

What is shingles?
Shingles is a painful skin rash caused by the varicella zoster virus*. This is the same virus that causes chickenpox.Shingles most often appears in a band, a strip, or a small area on one side of the face or body. It is also calledherpes zoster.

Anyone who has had chickenpox can get shingles. It most commonly occurs in older adults and people who have weakened immune systems due to stress, injury, certain medicines, or other reasons. Most people who get shingles will get better and will not get it again. Sometimes, it can have lingering side effects, such as nerve pain, which is another good reason to get the vaccine and avoid getting shingles in the first place.

*Source: WebMD.com 

This article applies to:

  • California, Wisconsin, Virginia, Ohio, New York, Nevada, New Hampshire, Missouri, Maine, Kentucky, Indiana, Georgia, Connecticut, and Colorado
  • Small group (2-50 employees), Large group (50-1000 employees), Individual (under 65), and ANA Consultant
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