Shingles Vaccine

Shingles is a painful viral disease that affects more than one million Americans every year.  More than half of those cases happen in people age 60 or older. The CDC recommends a single dose of shingles vaccine for everyone age 60 and older. Beneficiaries must have vaccinations administered in a provider's office.
         
About Shingles:

• Shingles is caused by the varicella zoster virus, the same one that causes chicken pox
• The virus remains dormant in those who’ve had the chicken pox
• It is not transmitted to others who had chicken pox, but can pass to those who have not had chicken pox, causing chicken pox
• Victims are commonly those over 60 years of age, those with other health problems, or those with high levels of stress

Coverage

TRICARE covers vaccines as recommended by the Centers for Disease Control (CDC) and Prevention. For beneficiaries 60 and older, TRICARE now covers Zostavax, the vaccine designed to prevent shingles. TRICARE officials caution that “covered” doesn’t necessarily mean “free” for TRICARE Standard or TRICARE for Life beneficiaries.
 
Zostavax is covered under the TRICARE medical benefit and is not reimbursable under the pharmacy benefit. Vaccines are not a part of the TRICARE pharmacy benefit because they can not be self-administered. Beneficiaries must have vaccinations administered in a doctor’s office.
 

Important differences between Medicare and TRICARE coverage:

	Shingle Vaccine under Medicare	Shingle Vaccine under TRICARE
Type of Benefit	Prescription Benefit	Medical Benefit
Coverage	Covered by Medicare Part D (prescription drug plan)	TRICARE pays for the vaccine as long as it is  purchased and administered by your doctor in the provider’s office.
Beneficiary Responsibility	You are responsible for the applicable deductible and cost share.	You are responsible for the applicable deductible and cost share.

Reimbursements

Remember  your TRICARE authorized provider has to provide  the vaccine and administer it as part of your office visit. You will NOT be reimbursed if you get the vaccine from a pharmacy, no matter who administers it.

Reimbursements for shingles vaccine under TRICARE Plans:

TRICARE Prime	TRICARE Standard/Extra	TRICARE for Life
As long as you get your shingles vaccine from your primary care manager you won’t be responsible for a deductible or copay.	You may get your shingles vaccine from any TRICARE-authorized provider (network or non-network) who is licensed to give the vaccine. Standard/Extra deductibles and cost shares apply	Medicare covers the shingles vaccine under Medicare Part D.  If you don’t have Medicare Part D, TRICARE will be the primary payer for the vaccine, although Standard deductibles and cost shares apply.