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A heart and a Medicaid card: Does Medicaid cover Shingrix?
Drug Info

Does Medicaid cover Shingrix?

Medicaid is likely to cover the shingles vaccine, but you may have to pay a copay for it
By | Nov. 4, 2024 Medically reviewed by Scott Dershowitz, LMSW, CMC

Key takeaways

  • Shingrix is a vaccine that protects adults against shingles, a painful rash caused by the reactivation of the chickenpox virus. 

  • The cost of Shingrix without insurance or Medicaid is about $283 per dose.

  • With the Inflation Reduction Act of 2022, Medicaid now fully covers vaccines, but only in states that have expanded Medicaid coverage, so coverage is highly dependent on where you live.

In this article:

Shingles is a painful condition caused by the reactivation of the varicella-zoster virus, which is the virus that also causes chickenpox. The chances of getting shingles increase with age as the immune system gets weaker. Shingles can lead to severe complications, including long-lasting pain and, in rare cases, eye or hearing damage.

Shingrix is a very effective vaccine recommended for adults 50 and older and those with weakened immune systems. It contains inactivated varicella-zoster, which aids the body in producing more antibodies than necessary to fight the virus with a stronger immune system response. Since the Centers for Disease Control and Prevention (CDC) recommends Shingrix to prevent shingles, and it is the only shingles vaccine, you may wonder whether Medicaid covers it as a prescription drug benefit.   

Does Medicaid cover Shingrix? 

Yes, but coverage varies by state. 

Starting in 2023, the Inflation Reduction Act of 2022 made vaccines more accessible for Medicare and Medicaid recipients. If you have Medicaid and live in a state with expanded Medicaid coverage, it’s likely that you will have low or no costs for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), and Shingrix is one of them. However, that’s only in states that expanded Medicaid under the Affordable Care Act. To date, 41 states have.

If you live in one of the states that have not yet expanded Medicaid, you may or may not have coverage for Shingrix. If you do, there may be age restrictions, and you may have to pay a higher copay or coinsurance. 

How much does Shingrix cost? 

Without insurance, Medicare, or Medicaid, Shingrix costs over $500 for both doses. But the cost of Shingrix can vary depending on several factors, including where you live, and which pharmacy you use. 

As of the time of publication, the average retail price of Shingrix is $283 per dose. But most people don’t pay this price if they have health insurance, including Medicaid.

Costs of Shingrix with Medicaid 

If you live in one of the 41 states that expanded Medicaid and get your vaccine with an in-network provider, you’re likely to pay less than $5 per dose of Shingrix, according to GSK, its manufacturer. Ultimately, however, the cost of Shingrix with Medicaid will depend on your state’s specific plan details. You might still have some out-of-pocket expenses, such as:

  • Copays: Some states require a small fee for vaccines, but this amount is usually minimal compared to the total price.
  • Coinsurance: In some cases, you might need to pay a percentage of the vaccine’s cost. The exact amount will depend on your state’s Medicaid rules.

How to get Shingrix with Medicaid 

If you have Medicaid, here’s how to go about getting the shingles vaccine:

  • Talk to your healthcare provider to see if Shingrix is right for you. According to the CDC, some people should not get Shingrix.
  • Check with your state’s Medicaid office or visit its website to confirm that Shingrix is covered. Your pharmacist can also help you verify coverage. Most in-network providers offer Shingrix with little to no cost. 
  • Your healthcare provider may administer Shingrix in the office or give you a prescription for it and refer you to a pharmacy that provides the vaccine. 
  • If Medicaid requires prior authorization, your healthcare provider will submit the necessary forms to Medicaid. Once approved, you can get the vaccine at your healthcare provider’s office or a pharmacy that’s in-network with your Medicaid plan.
  • After your first dose, you’ll need to schedule your second dose, which you can get two to six months after the first dose.

Ways to get discounts on Shingrix without Medicaid 

If you don’t have Medicaid or your state Medicaid program doesn’t cover Shingrix, there are still ways to save on the vaccine. One way is to use the SingleCare prescription discount card, which can help you save on Shingrix at many participating pharmacies. For example, the card can give you access to a digital SingleCare coupon that can reduce the vaccine cost from $283 to $221 per dose. 

RELATED: Is Shingrix covered by Medicare?

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