Shingles vaccine is limited by cost and coverage

Good health is only affordable—for the majority of the population—if it is covered by insurance. An excellent case in point is the vaccine for shingles (herpes zoster).

Shingles is the revisiting of the chicken pox virus. The virus lives in the body since the first episode of shingles as a child, and then flares up during later adulthood to give shingles.

Shingles is rarely life-threatening, but it is immensely painful and debilitating, and not very amenable to treatment. Most patients end up suffering intense pain and can have complications that last for months. Shingles will attack up to 1/3 of the population.

So doctors and patients alike were delighted when a shingles vaccine was approved in 2006. It prevents many cases of shingles, and significantly decreases pain in the others.

It is safe enough and effective enough to be recommended by the CDC as a standard vaccine for adults 60 and older. It is now one of components of preventive medicine, taking its place alongside colonoscopy, mammograms, flu shots and pneumonia vaccines.

Except there is a problem: cost and coverage. The vaccine costs about $200 and most insurances do not cover it. (For comparison, seasonal flu shots cost about $20).

An article in the Annals of Internal Medicine recently found that less than 10% of people who were eligible for the shingles vaccine received it. The major barrier—no surprise—was that it wasn’t covered by insurance.

This highlights the issue of how medical care is determined by insurance companies (both private and Medicare), rather than by medical recommendations and scientific data.

Of course there are financial limits on what our system can afford. However, it seems that primary care interventions should get priority. Primary care is the first (and often the only) line of defense for most people’s health. This is something that is surely ripe for reform.

Danielle Ofri is an internal medicine physician and author of What Doctors Feel: How Emotions Affect the Practice of Medicine.

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  • Alice

    What if it’s not just finances keeping people from receiving the vaccine? Some people just don’t want it, some people have philosophical objections, and some religious (the culturing of the vaccines in aborted baby parts, and some take little solace in animals used in cultures).

    The H1N1 vaccine was cheap enough (even free), and a whole lot people simply didn’t want it. Not everyone views vaccines as the panacea most of the medical community does.

    The bottomline is that even amidst all the bad input of data, which ultimately means some bad output, the public is skeptical and asking questions (and finding answers in a way that was never quite possible). As bothersome as that can be I think it’s great that patients question what is going into their body. No more shots in the dark. And it’s, also, great that the screams (that were supposedly from the ill-informed radicals) made the shots safer. So, you battle misconceptions, and you battle some real truths, not always finances.

    Some moms prefer chicken pox parties. I am glad we still have a choice in these matters.

  • ErnieG

    I tend to disagree with Dr. Orfi that the vaccine should be covered by insurance. The vaccine is a one time event. It is “budgetable”, the benefit it provides to the patient can be easily understood by the patient, and the disease it prevents is not life threatening. Anytime a third party payer (i.e. insurance) gets involved, the costs go up and the true costs are not transparent.

    There needs to be a movement in this country away from the idea that insurance=medical care to the idea that patients have skin in the game in their medical care.

  • http://nostrums.blogspot.com Doc D

    What we need is data on the social and medical cost of care for shingles that could have been prevented by the vaccine. Shingles can be so miserable and unremitting that I’ve had patients who considered committing suicide.

    Only 3 out of every 10 new drugs end up paying for themselves, allegedly. I want researchers and developers to keep woking on better things, so I’m OK with higher prices, when many drugs (and vaccines) cost $1-2B to develop. I can’t say whether $200 is fair, though.

    The shingles vaccine is recommended for me, and I want it. I’ve had shingles once, and never want it again. My insurer covers it, but only if bought by, and administered by, my doctor. They won’t cover it if my doctor sends me to the pharmacy with a prescription, nor will they let me give it, or a pharmacy give it. So, coverage alone is not the answer: some doctors don’t want to invest a ton of money keeping the vaccine on hand (expiraton dates and all that).

    So I have to convince my doctor to buy it or come up with the cash.

    BTW, kids die of chickenpox…extremely rarely, thank goodness (look up chickenpox pneumonia, and chickenpox encephalitis). I’m not aware of any (proven) chickenpox vaccine deaths. Neither natural chickenpox nor the chickenpox vaccine prevents shingles.

  • stargirl65

    Alice
    People do want the vaccine. Many of my patients request the vaccine. I cannot afford to carry it in my office since the insurance companies pay me LESS than the cost of the vaccine. Patients have to get it at the pharmacy. Most don’t fill the prescription when they find out it is $200 cash.

    ErnieG
    The insurance companies do not pay well for vaccines. The insurance companies barely cover the cost of many vaccines (you might get up to $3 profit if you are lucky) and on some vaccines they pay less than the cost of purchasing the vaccine. I am not sure that the cost of the vaccine would rise if insurance were involved. They might be able to negotiate a fairer rate with the manufacturer and the cost might actually decrease.

  • Alice Robertson

    I agree with some of what you are sharing. But I think there are problems with true immunity. Unless the child gets a good dose of chickenpox they will be susceptible to shingles. When I was a child I had a mild case of chicken pox, which means I did end up with shingles as a young adult. You are right, it was horrible, but the vaccine most doctors are recommending isn’t going to be as fullproof as many believe it to be. Shingles will rise in adults, and so another vaccine…………and on and on……..

    Vaccines are safer, but often less potent (i.e. tetanus). My kids all had chicken pox naturally (there is only a small percentage of kids who are at risk of dying from chickenpox, but sometimes medical science makes such broad sweeping conclusions a whole population becomes scared witless).

    I don’t know…..sometimes it just seems like Chicken Little should be the Surgeon General.

  • Alice

    If your patients want the vaccine why aren’t they using the Health Department to get it cheap or free, or a clinic? I just got home from Cleveland Clinic (my daughter’s cancer has spread to her lymphs, so my brain isn’t working right), but I just find myself wondering how much of our society actually needs that type of vaccine? It just seems like so many people are getting injected with this stuff that don’t need it. I guess what I am asking is if the vaccine for shingles wasn’t available how many will die, and how many will get sick? I had shingles once when I was in my twenties, and never again. If it’s seniors who are more susceptible, then why not campaign for a certain segment of society to get the shot? Of course, if the medical community knows the chickenpox shot will up the stats on shingles then I can understand why going the route of a band-aid that prevents chickenpox from doing what it normally does……….then I can understand that we are going to need another vaccine to complete the job the chickenpox vaccine created.

    More and more people are opting out of the vaccines. They worry about the immune system and long term damage. I didn’t vaccinate my child, but last fall had to watch her drink radiation. My knees went weak at that time. I found myself grateful I didn’t immunize her and that she is a vegetarian, because I felt she had a stronger immune system than most teens, but there are still side-effects from the radiation (her endo said today he doesn’t believe in more radiation after the first dose). I am so grateful to have found doctors who think outside-the-box. I am hoping medical school will produce a whole nation of doctors who don’t want to be part of the status quo, but with more and more government regulation I don’t foresee that. I, also, worry that parents are losing rights too.

  • stargirl65

    Alice

    The shingles shot is only indicated for people age 60 and up.

    The local health department does not carry the shot.

    My local health department does not supply free vaccines unless you are on medicaid or the CHIP program. They actually bill your insurance or you have to pay.

    The chicken pox vaccine actually decreases the rate of shingles.

  • Alice

    Thank you for your response.

    Hmmm…….I would dispute that the vaccine decreases shingles (but I understand we probably both have different sources and viewpoints, and the data minefield out there is treacherous to excavate). There are studies indicating otherwise (in Asia where the shot was available longer than here the long term affect was more shingles from lack of true immunity. Shots are a substitute, but speaking in a generalities, contracting a full-fledged disease is the only way to truly offer real immunity (realizing people are trying to avoid the “real thing”, but when it comes to immunity the “real thing” [when little risk is involved] is the best way).

    The shot will still only help a small minority of people whether it’s free or paid-for. And I believe it hurts the immune system of the elderly (who are just getting too many shots).

    My parent’s doctors doesn’t recommend they get the shingles vaccine.

  • ErnieG

    Stargirl65-
    Cost and price of vaccines are two different things. They way drugs/vaccines are priced are not according standart market economics (the payer is not the beneficiary). I am aware that insurances don’t pay well for vaccines- the reason is clear- docs will give it anyway and eat the cost because it is the “right” thing to do.

  • Nancy

    On Monday (June 28, 2010) a Boston VA hospital informed a 61 year old disabled vet that he could not receive the shingles vaccine because “there is a nationwide shortage”. Even if you want it, you can’t get it now? I emailed CDC to find out whether the VA assessment was true. The civilian doctor the vet went to wanted $300 for the vaccine. The VA seems to be shortchanging vets yet again. And given the costs in suffering and treatment of shingles, the VA may be doing itself no favors either.

  • Barbara

    I am considering getting the shingle vaccine. My daughter is 8 mos pregnant and I want to know when it is safe to be around her after I have the vaccine? Also, same question when the baby comes.