Recent events have pushed me to think about shingles, and not the roofing kind.
A few months ago, I entered my 60s, the age when the CDC recommends a person get the vaccine for shingles, a painful skin rash often accompanied by blisters.
Just recently, a friend who is my age told me that though he has concerns about getting shingles (one out of every three people will develop it) he won’t get the vaccine, called Zostavax, because of its cost. My friend said his health insurance plan doesn’t cover it.
And then I passed a Walgreens pharmacy whose outdoor signage tells passers-by that it has the shingles vaccine, along with other items that have special pricing.
So I wanted to get the facts – and the costs.
Shingles clearly is an experience you want to avoid. Merck, the maker of the vaccine, has produced a video of a retired firefighter who has battled the condition, which typically lasts two to four weeks.
Dennis Grogan says in the ad that he was a firefighter for 24 years, but he adds, “I have never encountered such a burning sensation until I had the shingles. . . . It’s something you never want to encounter.’’
Shingles is caused by the varicella zoster virus, the same one that causes chickenpox. Once you have had chickenpox, the virus stays in your body and can resurface as shingles.
I’m pretty sure I had chickenpox, along with my brothers, but I don’t recall it specifically. I was very young then.
The CDC says that in a clinical trial involving thousands of adults 60 years old or older, Zostavax reduced the risk of shingles by about half (51 percent) and the risk of post-herpetic neuralgia by 67 percent. While the vaccine was most effective in people 60 to 69 years old, it also provided some protection for older groups.
The vaccine, then, is not always going to prevent the condition. And what about the cost?
I called up the Walgreens that advertised the vaccine, and the pharmacy told me that it could cost more than $200 if a person paid the entire price, without insurance.
Zostavax is a big moneymaker for its manufacturer, Merck. The Wall Street Journal reported earlier this year that some analysts estimate Zostavax could generate annual sales of more than $1 billion for Merck within a few years. Merck recorded $332 million in Zostavax sales for 2011.
Merck’s catalog price — that is, the price available to any customer eligible to purchase vaccine directly from the company — is $167.15 for the single-dose vial and $159.32 per dose as a package of 10 single-dose vials, according to a spokeswoman, Pam Eisele.
“The overall price of Zostavax reflects the innovation that Zostavax represents, the value that it offers in its therapeutic area, and Merck’s overall costs for research and development and manufacturing,” Eisele said in a statement Monday.
The company said more than 90 percent of adults are in private plans and Medicare Part D plans that provide reimbursement for Zostavax.
“Whether Zostavax will be reimbursed for a particular patient will depend on the patient’s benefit design with respect to all adult vaccines, including the application of any co-pay, co-insurance, deductible and/or coverage limit,’’ added the statement from Eisele.
Merck also said people may be eligible for a rebate if they have an out-of-pocket cost of more than $30 (check out www.rebate4zostavax.com for details). And for the uninsured, the vaccine may be available through the company’s Vaccine Patient Assistance Program. Details on this can be found at www.merckhelps.com or by calling 1-800-293-3881.
Dr. Thad Riley, a family physician in Statesboro, said that if insurance covers the vaccine, the co-pay is usually about $30. But for those without coverage, he said, “We can’t give it out for free,’’ noting that it costs more than $200.
Riley said he has seen a trend toward more health insurers covering Zostavax. “We recommend it all the time,’’ he said. “Most of [the patients] would like to have it.’’
My friend’s lack of coverage and the possible $200 price tag was enough to have me check whether it was a covered expense under my own health plan.
This type of price checking is increasingly common, with consumers having to decide whether a health care service is worth the cost. For someone without insurance, or with a high-deductible health plan, the decision can be difficult.
My doctor’s office called up my insurer and found out the health plan would cover it. So I’m one of the 90 percenters.
I wasn’t told the amount of the co-pay. But as long as that is in the regular co-pay range, I’ll get the shot.
I would hate to have to take my chances, as my friend is doing. The warnings about shingles are painfully convincing.
Here’s a video interview of Dr. Janis Coffin, medical director of the Family Medicine Center at the GHSU Health System, discussing shingles: