If you’re considering the Shingrix vaccine and are wondering whether your prescription drug plan, such as SilverScript, covers it, you’re not alone. Shingrix is a vaccine recommended for preventing shingles, a painful condition caused by the varicella-zoster virus. Many people seek to get vaccinated as a way to reduce the risk of developing shingles, particularly those over 50. SilverScript, a prescription drug plan available through the Medicare Part D program, offers coverage for a variety of medications, but whether it covers Shingrix depends on specific details. This article will explore whether SilverScript covers Shingrix, how the vaccine works, and important information to keep in mind when considering getting the vaccine.
What is Shingrix?
Shingrix is a vaccine designed to protect adults 50 years and older from shingles. It is a two-dose vaccine that helps boost immunity against the varicella-zoster virus, which causes chickenpox and shingles. Even if someone has had chickenpox or the chickenpox vaccine in the past, they can still develop shingles as they age. Shingrix is recommended because it has been proven to be highly effective in preventing shingles and its complications, such as postherpetic neuralgia (PHN), a long-lasting nerve pain that can occur after shingles.
Shingrix is not a one-time vaccine; it requires two doses. The first dose is given at least two months after the second dose. The vaccine is recommended for individuals over the age of 50, regardless of whether they have had shingles before. It can be administered at pharmacies, doctor’s offices, and health clinics.
Does SilverScript Cover Shingrix?
SilverScript is a Medicare Part D prescription drug plan, which means it helps cover medications, including vaccines, that are approved by the Food and Drug Administration (FDA). Coverage for vaccines under SilverScript, as with any Medicare Part D plan, depends on a few factors, such as your specific plan and where you get the vaccine.
In general, SilverScript covers vaccines that are recommended by the Centers for Disease Control and Prevention (CDC) for adults. Shingrix, as an FDA-approved vaccine recommended for adults 50 years and older, is typically covered by SilverScript plans, but coverage may vary. Some plans may cover the vaccine at no cost to you, while others might have certain copayments or restrictions.
To understand whether your specific SilverScript plan covers Shingrix, you should:
- Review your plan’s formulary (the list of covered drugs and vaccines).
- Contact SilverScript customer service or visit their website for specific details on coverage.
- Speak to your healthcare provider or pharmacist, who can help guide you through the process of receiving the vaccine under your plan.
SilverScript and Medicare Part D
SilverScript is one of several Medicare Part D prescription drug plans available to beneficiaries. Medicare Part D provides coverage for prescription medications, and some Part D plans also cover certain vaccines, including Shingrix. The way SilverScript and other Medicare Part D plans work is that they are broken down into different tiers. Each tier reflects the cost and coverage level for specific drugs, including vaccines.
Shingrix is often categorized under a higher-tier medication because it is a specialty vaccine. This means that the cost of the vaccine may vary depending on your plan and whether it’s covered under a preferred pharmacy or network. Some SilverScript plans might cover the full cost of the vaccine, while others may require a copayment or coinsurance. It’s essential to check the details of your plan to understand how much you will need to pay.
Cost of Shingrix with SilverScript
The cost of the Shingrix vaccine can vary widely depending on your SilverScript plan, your deductible, and the pharmacy you choose. In general, the cost of the Shingrix vaccine without insurance can be quite high, often ranging from $150 to $200 per dose. Since it requires two doses, the total cost could be between $300 and $400 for the complete vaccination series.
For those with SilverScript or any Medicare Part D prescription drug plan, the cost may be lower, but it depends on factors such as your specific plan and whether you’ve met your deductible. Here are some scenarios that may apply:
If Shingrix is covered at no additional cost: Some SilverScript plans may cover the full cost of the vaccine. If this is the case, you could receive both doses of Shingrix for no out-of-pocket expense, provided the vaccine is administered at an in-network pharmacy or doctor’s office.
If there is a copayment or coinsurance: Other SilverScript plans might cover Shingrix with a copayment or coinsurance. The amount you would pay will depend on the tier the vaccine falls under in your plan’s formulary and whether the vaccine is covered under the network.
If you haven’t met your deductible: Some SilverScript plans have a deductible that must be met before coverage begins. If you haven’t yet met your deductible, you might need to pay the full cost of the vaccine until you reach that threshold.
Out-of-network pharmacies: If you receive Shingrix at an out-of-network pharmacy, you might pay more for the vaccine. Always check to ensure that the pharmacy is in-network to avoid extra costs.
What You Need to Know About Shingrix and Medicare Coverage
While SilverScript plans often cover Shingrix, there are other important things to know when considering the vaccine and Medicare coverage:
The vaccine is covered under Part D: Shingrix is not covered under Medicare Part B, which covers other vaccines like the flu shot and pneumonia vaccines. This means that you will need to rely on your Medicare Part D plan, like SilverScript, for coverage of the Shingrix vaccine.
Medicare Part B vaccine coverage: Medicare Part B typically does not cover vaccines like Shingrix, except in specific situations. For example, Part B will cover certain vaccines for people with Medicare if they have a specific medical condition, such as those at high risk of contracting certain diseases.
Pharmacy and doctor’s office administration: Shingrix can be administered at a pharmacy or a doctor’s office. If it’s given at a pharmacy, it may be easier to have the cost covered by your SilverScript plan. However, if you receive the vaccine at a doctor’s office, your physician may bill you directly, and the coverage will depend on the details of your SilverScript plan.
Medicare Advantage plans: If you have a Medicare Advantage plan that includes prescription drug coverage (MA-PD), it may cover the Shingrix vaccine. Be sure to check with your plan to confirm coverage.
What Should You Do Next?
If you are ready to get vaccinated and are unsure whether your SilverScript plan covers Shingrix, there are several steps you can take:
Check your plan’s formulary: Review your SilverScript plan’s formulary or medication list to see if Shingrix is included. The formulary will tell you if the vaccine is covered and the cost associated with it.
Call SilverScript customer service: If you’re still unsure, call SilverScript customer service for clarification. They can explain whether your plan covers Shingrix, what you will need to pay, and where you can get the vaccine.
Speak to your healthcare provider: Your doctor or pharmacist can provide more details about getting the Shingrix vaccine and may help you navigate the process of obtaining it under your SilverScript plan.
Look for in-network pharmacies: To minimize out-of-pocket costs, make sure to get the vaccine from a pharmacy or doctor’s office that is in-network with your SilverScript plan.
Conclusion
SilverScript often covers Shingrix as part of its Medicare Part D plan, but there are some variations depending on your specific plan. Understanding the costs, coverage, and how to get the vaccine will help you make an informed decision. Be sure to review your plan details, talk to customer service, and check with your healthcare provider to ensure that you receive the Shingrix vaccine at the lowest possible cost.
Getting vaccinated with Shingrix is an important step in preventing shingles and its complications. By confirming your SilverScript coverage, you can take the necessary steps to protect your health and well-being as you age.
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