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UnitedHealthcare adds Shingrix vaccine to preventive benefits beginning April 1
February 10, 2018
On Oct. 20, 2017, the U.S. Food and Drug Administration (FDA) approved the new shingles vaccine, Shingrix®, for the prevention of herpes zoster in adults ages 50 years and older. On Jan. 26, 2018, the Advisory Committee on Immunization Practices (ACIP) recommendations on Shingrix were adopted by the Centers for Disease Control and Prevention (CDC) with its publication in the Morbidity and Mortality Weekly Report (MMWR).
According to the ACIP recommendation, Shingrix is:
- Recommended for healthy adults ages 50 years and older to prevent shingles and related complications;
- Recommended for adults who previously received the Zostavax® shingles vaccine to prevent shingles and related complications; and
- The preferred vaccine for preventing shingles and related complications.
Network coverage at no cost share
For non-grandfathered, fully insured and self-funded customers that follow UnitedHealthcare standard preventive services benefits, Shingrix will be included as a covered benefit beginning April 1, 2018.
Shingrix is paid as preventive under the medical benefit, not the pharmacy benefit.
ACIP has not recommended Shingrix for individuals ages 49 and younger.
Coverage for the Shingrix vaccine at no cost share is available in network through most:
- Physician’s offices.
- Urgent care centers.
- National convenience care clinics*:
- MinuteClinic® located in CVS®, Target® and Longs Drugs
- Walgreens® Healthcare Clinic
- RediClinic® located in Rite Aid® and H-E-B®
- The Little Clinic® located in Kroger®
- Walmart® Care Clinic
- National retail pharmacies* that are contracted to administer the vaccine.
* Eligible members may show their health plan ID cards to receive the Shingrix vaccine on a walk-in basis from these national providers.
Preventive care services CDG code and benefit limits
CDG Code Covered
Zoster (shingles) vaccine (HZV), recombinant, sub-unit, adjuvanted, for intramuscular use. Requires 2 injections.
Zoster (shingles) vaccine (HZV), live for subcutaneous injection. One injection.
Refer to UnitedHealthcare Preventive Care Services Coverage Determination Guideline for a list of vaccines and supporting information that are covered at no cost share.
Please contact UnitedHealthcare if you have questions.
January 1, 2018 PDL Updates
The following updates will take effect for the OptumRx direct Prescription Drug Lists (PDLs) on January 1, 2018. Learn more
New Sales Automation Management Tool
Check out our new Sales Automation Management (SAM). Learn more
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