The shingles vaccine is highly effective—but billing for it can be a headache
Industry Buzz
If you stock [the shingles vaccine] in your office and administer it to your patients who are between 50 and 64, their private insurance will pay for it, and you can get an administration fee.
—William Schaffner, MD
A lot of times people look at the vaccine schedule, and it can be so complicated and confusing that to some people—even health professionals—it can look random. It’s not; it’s all evidence-based. And there’s reasons that some vaccines are different at certain ages [and] at certain times.
—Dean Blumberg, MD
The shingles vaccine is over 90% effective, but it can pose administrative difficulties for practicing physicians.[]
Some patients will have the cost of their vaccination covered by Medicare, some through Medicaid, and some through private insurance.
“For physicians in the United States, the payment for the vaccine is a bit tricky. For people aged 65 and older, it’s covered under Medicare. However, it’s covered under Part D of Medicare, which was designed as the prescription drug benefit. Part D has enough administrative [nonsense], such that many physicians in their offices do not deal with Part D vaccines. So, if you do not want to mess with Part D—if your office is not set up for that—please, for your patients aged 65 and older, not only recommend but insist that they go to a pharmacy to receive the vaccine,” William Schaffner, MD, an expert in infectious diseases at Vanderbilt University, tells MDLinx.
Dr. Schaffner notes, though, that there is an administration fee for physicians who administer the shingles vaccine to certain age groups.
“Now, how can the physicians get in the game? How do they have skin in the game? Well, the recommendation is, of course, for everyone aged 50 and older to receive the vaccine. So if you stock [the shingles vaccine] in your office and administer it to your patients who are between 50 and 64, their private insurance will pay for it, and you can get an administration fee. And the sooner you vaccinate, the better,” he says.
Related: The FDA blocked shingles vaccine safety studies—here’s how to counsel your patientsWho should get the shingles vaccine?
In the US, the recombinant zoster (shingles) vaccine, known as Shingrix, is administered as a two-dose series.[] It is recommended for those aged 50 and older, as well as those aged 19 and older with weakened immune systems.
In adults aged 50 and older, the two doses should be separated by 2 to 6 months, and in adults 19 and older with weakened immune systems, a second dose can be given 1 to 2 months after the first dose if needed.
“A lot of times people look at the vaccine schedule, and it can be so complicated and confusing that to some people—even health professionals—it can look random,” says Dean Blumberg, MD, an expert in infectious diseases at the University of California, Davis. “It’s not; it’s all evidence-based. And there’s reasons that some vaccines are different at certain ages [and] at certain times.”
In addition to preventing shingles, the vaccine also prevents postherpetic neuralgia (PHN), a long-term form of nerve pain that can be severe and debilitating.[] It is the most common shingles complication.
Related: Multivitamins, mortality, and longevity: Growing data for the ongoing debateVaccinating older patients
There is no upper age limit for receiving the shingles vaccine. In people aged 70 and older with healthy immune systems, the immunity from the shingles vaccine remains high for at least 7 years following vaccination.[]
Dr. Schaffner says that while there are additional complexities for physicians in receiving payment for vaccinating older patients, physicians must still take steps to assist older people and ensure that they are properly vaccinated.
“It’s good public health, it’s good patient care, and you will be reimbursed if you vaccinate early, between [the ages of] 50 and 64,” Dr. Schaffner says. “But don’t neglect your older patients because the risk of shingles goes up with …age.”
“Make sure, if you don’t wish to vaccinate [older people] in your office, that they go to a pharmacy to get the vaccine, and then inquire the next time you see them whether they did that. You need to follow that up,” Dr. Schaffner says.