With only one manufacturer of the Shingles Vaccine, Zostavax from Merck, there are no generic prices on the market. The retail price for Zostavax at the local pharmacies I surveyed is fairly consistent across the board. Lower prices can be found under different Medicare Part D Prescription Drug Plans, but even with insurance, there can be a spread of $115 to $170 difference in the cost.
Shingles vaccine retail pricing
If you are to walk into a pharmacy in the Sacramento area, without any insurance coverage, you will be charged $215 to $240 for Zostavax. These prices were quoted to me over the phone on August 19, 2013, from pharmacies in local Sacramento area. I followed up in June of 2015 and received similar over-the-counter price quotes.
|Zostavax Price Quote|
|August, 2013||June, 2015|
Factors influencing Zostavax price
If you have health insurance that covers prescription drugs, the cost will vary based on several factors.
$0, over 60 under ACA
Health plans will cover the shingles vaccine at $0 copayment if the member is over 60 years old and it is administered at their yearly “no cost” preventive physical. Vaccination for the Herpes Zoster virus is part of the preventive benefits all health insurance must include under the Affordable Care Act. This means that individuals that gain affordable health insurance under the Affordable Care Act in 2014, and are over 60, will be able to qualify for the shingles vaccine, Zostavax.
Under 60 shingles vaccine price
If you are under 60, before Zostavax is eligible for a copayment it must be in the formulary of prescription medications covered in your health plan. Several insurance companies have included the shingles vaccine within their formulary. Your doctor will have to determine if Zostavax is “medically necessary” in order for the vaccine to be eligible for a copayment or reduced price. Some health plans also include the shingles vaccine for individuals age 50 to 59.
One reader reported that she called her health insurance plan and they said she could receive the Zostavax vaccine at no cost at one of the health plans preferred pharmacies. Call your health plan to confirm they will cover the shingles vaccine if you are over 60 years old at one of their participating pharmacies. – January 8, 2015
The cost of Zostavax can also be influenced by which pharmacy you select. Insurance companies and Medicare Part D Plans have contracts with different pharmacies that includes negotiated pricing. It’s important that you determine which pharmacies in your area are “in-network” with your health insurance. Insurance won’t cover the costs for medications purchased outside of the network unless certain conditions are met. You can call your insurance or local pharmacy to determine which store has the best price. The price may vary from $10 to $20 between pharmacies, so it doesn’t hurt to shop around.
Tier level of prescription
Another factor will be which tier the insurance company lists the Zostavax injection. There are generally four or five tiers, each with increasing copayments, within a health insurance pharmacy benefit. A typical tier structure will have –
- Preferred generics
- Non-preferred Generics
- Preferred Brand Names
- Non-preferred Brand names
- Injection drugs
Zostavax is usually listed as tier 3 or 4 on the plans I have researched. Although, just because your insurance lists Zostavax as a Preferred Brand Name, it may still be more expensive than a plan that lists it as a tier 4 Non-preferred Brand Name medication. This all has to do with the type of plan, whether it has a deductible and price negotiated between the insurance carrier and the pharmacy.
Deductible pharmacy plans
Finally, there may be no discount from the retail price if you haven’t met your deductible for the prescription drug plan. This is regardless of whether the insurance is private, employer or Medicare. If your plan has a $250 pharmacy deductible and you haven’t made any purchases towards meeting the deductible, you’ll be paying the full negotiated price, even if Zostavax is included in the formulary.
Medicare Part D Plan Coverage
|Part D Plans Sacramento Area 2013 Zostavax Cost|
|$325 Deductible Plan|
If you have a Part D Plan with a $325 deductible, and have not made any prescription drug purchases adding to the deductible, you would be responsible for the full negotiated retail price. The Initial cost is after you have met your deductible.
|Part D Plans Sacramento Area 2013 Zostavax Cost|
|$0 Deductible Plan|
If your Part D Plan has no deductible, you go straight into the copayment pricing. These cost figures were acquired from the medicare.gov website for different plans in Sacramento County for 2013.
If you don’t have insurance or are tight on money, Merck has a Patient Assistance Vaccine program that can significantly reduce the cost. You will need to fill out a form and have your health care provider fax it over to Merck for consideration. They state that they try to process the form within 10 minutes. There are income qualifications. Even if you have health insurance, but have extenuating circumstance, you may qualify. The program is also available for other specialty vaccines Merck manufactures like Human Papillomavirus Quadrivalent, Hepatitis B Vaccine, Hepatitis A Vaccine and Varicella Virus.
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