Roll up your sleeve and get out your wallet, doctors say this vaccine is worth the $

There’s a new vaccine to prevent shingles, a skin rash that can be extremely painful, and if you are 50 or older or have parents or grandparents who are that age, you’ll probably want to learn more about it.

The new vaccine, called Shingrix, could be available by early next year.

The price of the two-dose vaccine could give some consumers sticker shock. But doctors say the $280 cost can be worth it to avoid getting shingles.

Shingles, also called herpes zoster, happens when the chickenpox virus roars back to life in adulthood; and it’s infamous for the severe pain many experience. About one in three people in the United States get shingles. And in about one in five people who are affected, the pain from shingles can last long after the rash and accompanying blisters have disappeared.

A Shingles vaccine can reduce the risk of shingles – and lessen the pain for those who do get it.

“It’s an important vaccine,” said Dr. Alan Kelton, a Fresno primary care physician.

Kelton said his 87-year-old grandmother had shingles on her chest. “If no one was in the house, she wouldn’t wear a top,” he said. “She said the pain was like ‘fire.’ ”

Up until now, there has been one shingles vaccine, Zostavax, made by Merck. It was approved for people 50 and older, but recommended by the federal Centers for Disease Control and Prevention for people 60 and older. According to the CDC, Zostavax reduces the risk of shingles by about 50 percent. Shingrix – made by GlaxoSmithKline – has been recommended for consumers age 50 and older. It has been shown to reduce the risk of shingles by about 90 percent.

In October, an advisory panel of the CDC recommended Shingrix over Zostavax. And it recommended that adults who previously had the Zostavax vaccine to be inoculated with Shingrix.

For the price, there is not much savings from Zostavax, a single-dose vaccine that costs about $200, and the $280 for Shingrix.

But how much a consumer has to pay out-of-pocket for a shingles vaccine can vary, depending on type of insurance.

For consumers in their 50s who want the vaccine, there could be some good news. Many people in this age group are still working and have insurance coverage through their employers.

“Our anticipation is that most insurers will cover CDC policy. That’s typically what happens,” said Gwynne Oosterbaan, spokeswoman for GlaxoSmithKline.

And if you buy insurance through Covered California, the state’s Affordable Care Act insurance marketplace, the vaccine should be covered. According to the CDC, shingles vaccine is one of the shots that all of the health insurance plans usually cover without charging a copayment or coinsurance when the vaccine is given by an in-network provider. And you don’t have to meet your yearly deductible.

Medi-Cal, the state-federal insurance program for low-income adults, children and people with disabilities, also covers Zostavax; and it will update its coverage and reimbursement policy for Shingrix, the agency said.

Vaccine coverage, however, is a little less clear-cut if you’re a senior.

Medicare Part B, the federal health insurance for older Americans and people with disabilities, does not pay for shingles vaccine.

Unlike the flu shot, the shingles vaccine is only covered if seniors pay a monthly premium for a standalone Medicare Part D prescription drug plan or have a Medicare Advantage plan that includes the prescription coverage. Seniors who buy Medicare supplemental plans could be reimbursed for their out-of-pocket costs.

Oosterbaan doubts Medicare Part B rules will change to include reimbursement for Shingrix.

So some seniors will have to shop around for the lowest cost – and that usually means comparing vaccine prices at pharmacies.

Most doctors have not stocked Zostavax in their offices because Medicare wouldn’t pay for it, Kelton said. And he says it’s unlikely many will stock Shingrix.

There’s enough incentive to get a shingles vaccination, however, that he’s not worried that cost will deter consumers from taking advantage of the new vaccine. “It’s been my general observation,” Kelton said, “that if someone has seen a friend or family member with shingles, they will go out and get it whether they have to pay for it without insurance.”

This story was originally published November 6, 2017 at 1:29 PM with the headline "Roll up your sleeve and get out your wallet, doctors say this vaccine is worth the $$."