Seniors have been particularly slow to take advantage of the shingles vaccine. The Food and Drug Administration approved it a decade ago, and the C.D.C. recommends it for those over 60, including those who’ve already had shingles.
Coverage has climbed steadily, but in 2014 had still reached only 31 percent of those over 65. As with nearly all of these vaccines, older whites were more likely to have been vaccinated than blacks, Hispanics or Asians.
Seniors and their caregivers should request vaccinations; the C.D.C. publishes guidelines and a quiz that explain which ones are recommended. Zostavax, the current shingles vaccine, reduces the risk of the disease in adults over 60 by half, and the incidence of postherpetic neuralgia by two-thirds.
(Quick primer: Shingles results from the same virus that causes chickenpox, which nearly all older Americans have had. The virus typically remains dormant for decades, but the odds of its reactivation rise steeply after 50 as the immune system weakens. The lifetime risk of shingles is one in three, rising to one in two for those over 85.)
The vaccine’s underuse can be blamed, in part, on supply shortages in its early years until about 2012. The manufacturer, Merck, and the C.D.C. didn’t increase media campaigns until vaccine supplies were sufficient; such campaigns had just started when Ms. Abate became ill. It’s not surprising that she was only vaguely aware of Zostavax.
Cost remains a barrier to getting Zostavax and some other adult vaccines.
In a study published this past summer, researchers reported that nearly 40 percent of the time, patients over 50 who requested a prescription for Zostavax at a pharmacy chain chose not to receive the vaccine; out-of-pocket costs were most frequently the reason.
The Affordable Care Act requires private insurers to cover Zostavax without co-pays for people older than 60, and many cover it for policyholders over 50. But Medicare beneficiaries find that, unlike the flu and pneumococcal vaccines, which are covered under Part B and often administered in physicians’ offices, Zostavax and Tdap are covered under Part D.
Physicians can’t easily bill for Part D reimbursement, so they often send patients to pharmacies, which can. But because Part D involves a welter of different plans and formularies, some requiring patients to pay for the vaccine and then seek reimbursement, the cost and co-pays can discourage use. Zostavax, at about $200 a dose, is the most expensive adult vaccine.
This landscape could change drastically in a year or so. In October, the pharmaceutical giant GlaxoSmithKline submitted a new shingles vaccine for F.D.A. approval.
International studies indicate that the newcomer, Shingrix, is far more effective than the current vaccine, reducing the incidence of shingles by 90 percent. Moreover, the effectiveness doesn’t appear to decrease among older age groups, as Zostavax’s does.
Shingrix has its own drawbacks. For one, it requires a second injected dose several months after the first; some people won’t follow up. The manufacturer has yet to set a price, and unless Congress changes the law, any new vaccine will face the same Part D billing complications.
But if the F.D.A. approves it, and the C.D.C. recommends its use (which triggers insurance coverage), Shingrix may also prevent a lot of shingles cases — but only if older adults are actually vaccinated.
They don’t have a great track record.
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Seniors have bee avoiding getting vaccinated for shingles even though the Affordable Care Act requires private insurers to cover Zostavax without co-pays for people older than 60 (read “Early Shortages, Delayed Marketing, High Prices, Other Health Priorities, Among Reasons Why Seniors Skip Shingles Vaccine”; http://sco.lt/4wT9NZ Perhaps the side effects mentioned in this article is a bigger reason.