Both our BCBSM and BCN (UM Premier Care) plans cover the Shingrix vaccine to protect against postherpetic neuralgia (shingles). The coverage is based on the Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) guidelines. They call for healthy adults age 50 and over to get the vaccine, which is delivered via two immunizations two to six months apart. The insurance plans will cover Shingrix even if the member previously received the Zostavax vaccine.
Insurance coverage is through the medical benefit, not the pharmacy benefit. The vaccine is covered in the physician’s office, and no copay is charged for the vaccine. A copay may be charged for the office visit, unless the visit is for a preventive/health maintenance exam. For retirees in Michigan, coverage is available at a pharmacy only if the pharmacy was contracted to bill BCBSM or BCN under the medical benefit.
For UM Premier Care, the vaccine is only covered if the physician is in network 1. A deductible will apply if the physician is in network 2.