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Insurance Coverage for Shingles (Shingrix) Vaccine

Health

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.

Click here for more information about the Shingrix vaccine.

8 thoughts on “Insurance Coverage for Shingles (Shingrix) Vaccine

  • The UMRA page re the Shingrix vaccine was not available. Can yu supply the info? Thank you.

  • This vaccine is in big demand and I am now on numerous “waiting lists’ including COSTCO, Walgreens and Rite Aid. Pivoting to getting vaccine at Pharmacy was at the suggestion of my Primary Care Physician-it seems pharmacies are getting a larger share of the distribution from the provider.

  • Being out of state, will our vaccine be covered if not given in a physician’s office? As Claudette said in her comment above, the pharmacies are supposedly receiving more vaccine than my physician. I have registered at Safeway and Walgreens as well as at my physicians, but need to know if it will not be covered unless given at a physicians office Thanks.

    1. Please contact your health insurance provider to obtain complete and accurate information about getting the Shingrix vaccine.

  • I am incredibly frustrated trying to get the Shingrix vaccine. I am 78 have BCBS & Medicare. Even if a local pharmacy has Shingrix in stock they are unable to bill BCBS.. BCBS told me today that it has to be billed under medical claim, not drug. Fine but heck of a time trying to get vaccine.
    Doctors’ offices do not administer vaccine.

    1. Hi Susan. It is frustrating. Sorry. I was on the waiting list at my U-M affiliated primary care doctor for a little over a year. I received my first dose one month ago. There are two doses required.

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