Billing Insurance For Shingrix: A Guide For Healthcare Providers

The cost of the shingles vaccine Shingrix can vary depending on your insurance coverage, the pharmacy you use, and the cost of the visit to your healthcare professional to receive doses of Shingrix. The price you pay will also depend on your treatment plan. If you have insurance, your insurance company may require prior authorization before covering Shingrix.

Shingrix is typically covered under Medicare Part D. Most people with Medicare Part D pay less than $50 per Shingrix dose. If you have Medicare Part D, you’ll likely need to get your Shingrix dose at a pharmacy, as most doctor’s offices aren’t able to bill Medicare Part D for vaccines.

Medicare Part D covers Shingrix

Medicare Part D covers the shingles vaccine, Shingrix, for people over 50 and those 18 and older who are at an increased risk of shingles. This is because the shingles vaccine is classed as a prescription drug, which is covered under Medicare Part D.

Medicare Part D typically covers the shingles vaccine for free, with no copayment or deductible. However, the amount you pay may vary depending on your chosen plan. Each plan categorises medications and vaccinations into different tiers, with higher tiers costing more.

If you are yet to get a Medicare prescription drug plan, you can sign up for Medicare Part D if you are eligible during the open enrolment period each fall.

GSK For You can help with Shingrix costs

• Have no third-party coverage for vaccines
• Be an adult, 18 or older
• Live in the United States or Puerto Rico
• Not be eligible for Puerto Rico's Government Health Plan Mi Salud or have applied and been denied
• Meet certain household income eligibility requirements

The following vaccines are currently included in the program:

• BOOSTRIX (Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed)
• ENGERIX-B (Hepatitis B Vaccine (Recombinant))
• SHINGRIX (Zoster Vaccine Recombinant, Adjuvanted)

You must enroll in the GSK Patient Assistance Program through your healthcare provider. Your healthcare provider will need to first register with the program and then submit your application.

GSK also offers programs to help patients without insurance access the cost of their medications, including Shingrix. GSK is committed to providing assistance if you can't afford their products. They have a range of programs and offers to help eligible patients get access to and financial support for the GSK medicines they need.

The list price for a 2-dose Shingrix vaccine regimen is $395.80 or $197.90 per dose. However, it's important to note that this is not the price most people pay. If you have health insurance, the price you pay is set by your prescription drug plan. Most people with Medicare Part D or employer-sponsored or privately purchased insurance have minimal to no out-of-pocket costs for recommended vaccines due to federal coverage requirements for preventive services.

The cost of Shingrix varies

• Insurance Coverage: The cost of Shingrix is typically covered by insurance plans. According to the manufacturer, 96% of privately insured people pay $0 for Shingrix. This includes Medicare Part D, Medicaid, private insurance, and ACA plans. However, it's important to check with your insurance provider to confirm coverage and understand any out-of-pocket costs.
• Out-of-Pocket Costs: For those without insurance, the cost of Shingrix can vary. The manufacturer, GlaxoSmithKline (GSK), reports that the average retail price for the two-dose vaccine series is $395.80, or $197.90 per dose. However, the price may be higher or lower depending on the pharmacy and location.
• Doctor's Visits and Administration Fees: In addition to the vaccine cost, there may be charges for doctor's visits and vaccine administration fees, which can vary. These fees are typically billed separately and may be reimbursed by insurance plans.
• Cost-Saving Options: There are several options available to reduce the cost of Shingrix for those without insurance or with high out-of-pocket costs. This includes patient assistance programs, prescription discount cards, and state pharmaceutical assistance programs.
• Medicare Coverage: As of 2023, the shingles vaccine is fully covered by Medicare Part D and Medicare Advantage plans, with no out-of-pocket costs for beneficiaries. This is due to the Inflation Reduction Act, which removed cost-sharing for recommended adult vaccines.
• Medicaid Coverage: Coverage for Shingrix under Medicaid varies by state. In states that have expanded Medicaid under the Affordable Care Act, Shingrix is likely covered with no cost-sharing, with an average cost of less than $5 per dose.

You can get Shingrix at a pharmacy or doctor's office

Shingrix is a prescription vaccine that helps prevent shingles (herpes zoster) in adults. It is a recombinant vaccine, made up of parts of the shingles virus that have been inactivated. It is not a live vaccine. The CDC recommends that healthy adults over the age of 50 get two doses of the vaccine to protect against shingles and its complications.

Shingrix is available at most pharmacies, including CVS, Walgreens, and Walmart, and can be administered by a certified immunizer. You can also get Shingrix at your doctor's office, but you should check with them first to see if they can bill your insurance directly for the vaccination. Most doctors' offices cannot bill for vaccinations.

The cost of Shingrix will depend on your insurance coverage and where you get the vaccine. If you have private insurance, Medicare, or Medicaid, you may pay little to nothing out of pocket for Shingrix. If you are uninsured, the cost of the vaccine will depend on the pharmacy or doctor's office where you get it. The average retail price for Shingrix is around $200 per dose, or $400 for the two-dose series.

If you are uninsured and cannot afford the vaccine, you may be able to get help with the cost. GSK, the manufacturer of Shingrix, offers a patient assistance program for those who qualify. You can also use prescription discount cards, such as GoodRx, to help lower the cost of the vaccine.

You can use a coupon to save on Shingrix

If you need help covering the cost of Shingrix, you can use a coupon to save money on the vaccine. Here are some options to consider:

GoodRx Coupon

GoodRx offers a coupon that can help you save on the cost of the Shingrix vaccine. The GoodRx coupon can be used at participating pharmacies, such as CVS Pharmacy, Target, Walmart Pharmacy, or Walgreens. The lowest GoodRx price for the Shingrix vaccine is about $151, which does not include administration fees. You can check the GoodRx website to find the latest prices and participating pharmacies in your area.

SingleCare Coupon

SingleCare offers a free savings card and coupons that can help you save on the cost of Shingrix. With SingleCare, you can lower the price of Shingrix to around $187 for 1, 50mcg/0.5ml Suspension Reconstituted. You can use the SingleCare coupon at participating pharmacies, such as CVS Pharmacy, Target, Walmart Pharmacy, or Walgreens. Visit the SingleCare website to sign up for free and find the latest coupon offers.

RxSaver Coupon

RxSaver offers coupons that can help you save on the cost of Shingrix. You can use the RxSaver coupon at participating pharmacies, such as Wegmans Food Markets, Inc. The estimated price with the RxSaver coupon is $20147. Visit the RxSaver website to find the latest coupon offers and participating pharmacies.

GSK Patient Assistance Program

The GSK Patient Assistance Program offers financial assistance for patients who need help paying for Shingrix. To qualify for this program, you must have no third-party coverage for vaccines, be an adult aged 18 or older, live in the United States or Puerto Rico, and meet certain household income eligibility requirements. You can call 1-866-728-4368 to request an application or download the application from the GSK website. Your healthcare provider will need to register with the program and submit your application on your behalf.

It is important to note that the availability and applicability of these coupons may vary based on your location and insurance status. Be sure to carefully review the details of each coupon and confirm your eligibility before using them. Additionally, it is always a good idea to consult with your doctor or pharmacist to understand your specific situation and explore all available options for saving on the cost of Shingrix.

Frequently asked questions