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UnitedHealthcare adds Shingrix vaccine to preventive benefits beginning April 1

March 7, 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 

Shingles Vaccine

CDG Code Covered

Benefit Limit

Description

Shingrix**

90750

Ages 50 and older

Zoster (shingles) vaccine (HZV), recombinant, sub-unit, adjuvanted, for intramuscular use.  Requires 2 injections.

Zostavax

90736

Ages 60 and older

Zoster (shingles) vaccine (HZV), live for subcutaneous injection. One injection.

**Shingrix is FDA approved and recommended by ACIP for use in immunocompetent adults aged 50 and older.

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.