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The Shingles Vaccination Out of Reach for Most – Cost, Red Tape for Compensation and Physician Worries About Safety

Posted Jun 16 2010 1:17pm

We hear talk in the news today about vaccines being the answer, well here’s an example of a vaccine perhaps being underused?  It’s the typical response from the insurers on not covering as well as Medicare from one side and on the other side the expense of a practice keeping the vaccine on hand and their related expenses image in providing.  

The article makes a lot of good points here with efforts from all around needing to get their heads together on this vaccine if we are to be able to take advantage and especially for seniors, which are the part of the population that is hard hit with development of Shingles later on in life.   Back in May of 2008 CDC recommend a shingles vaccine for those over 60.

It would at least make sense for Medicare and CDC to get their heads together on this one and perhaps the insurers would fall in line as well.  If we could see even a portion of the support we saw for the H1N1 vaccine we would be miles ahead.  BD   

Moreover, many private insurers require patients to pay out of pocket first and apply for reimbursement afterward . And because the shingles vaccine is the only vaccine more commonly given to seniors that has been treated as a prescription drug, eligible Medicare patients must also first pay out of pocket then submit the necessary paperwork in order to receive the vaccine in their doctor’s office. It’s a complicated reimbursement process that stands in stark contrast to the automatic, seamless and fully covered one that Medicare has for flu and pneumonia vaccines.

Despite this payment maze, some physicians have tried to stock and administer the vaccine in their offices; many, however, eventually stop because they can no longer afford to provide the immunizations. “If you have one out of 10 people who doesn’t pay for the vaccine, your office loses money,” said Dr. Allan Crimm, the managing partner of Ninth Street Internal Medicine, a primary care practice in Philadelphia. Over time, Dr. Crimm’s practice lost thousands of dollars on the shingles vaccine. “It’s indicative of how there are perverse incentives that make it difficult to accomplish what everybody agrees should happen.”

Last month in The Annals of Internal Medicine , researchers from the University of Colorado in Denver and the C.D.C. surveyed almost 600 primary care physicians and found that fewer than half strongly recommended the shingles vaccine. Doctors were not worried about safety — a report in the same issue of the journal confirmed that the vaccine has few side effects; rather, they were concerned about patient cost.

Although only one dose is required, the vaccination costs $160 to $195 per dose , 10 times more than other commonly prescribed adult vaccines; and insurance carriers vary in the amount they will cover. Thus, while the overwhelming majority of doctors in the study did not hesitate to strongly recommend immunizations against influenza and pneumonia , they could not do the same with the shingles vaccine.

Moreover, many private insurers require patients to pay out of pocket first and apply for reimbursement afterward . And because the shingles vaccine is the only vaccine more commonly given to seniors that has been treated as a prescription drug, eligible Medicare patients must also first pay out of pocket then submit the necessary paperwork in order to receive the vaccine in their doctor’s office. It’s a complicated reimbursement process that stands in stark contrast to the automatic, seamless and fully covered one that Medicare has for flu and pneumonia vaccines.

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