ZOSTAVAX: Zoster Vaccine Live

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YOUR STEP-BY-STEP GUIDE TO UNDERSTANDING INSURANCE COVERAGE AND OUT-OF-POCKET COSTS FOR THE SHINGLES VACCINE

The best way to find out how much the Shingles vaccine may cost you is to call your insurance provider directly.

ZOSTAVAX is covered by many private insurance and Medicare Part D plans. Because all plans are different, coverage can vary. In fact, you may be covered by more than one policy. Follow these suggested steps to help start the conversation and understand your potential out-of-pocket costs.

 
Out-of-pocket

The amount of money (including co-pays and deductible) you pay for health care services.

  • Call the phone number provided on the back of your insurance card to help you understand your coverage for the Shingles vaccine.

    If you have multiple insurance cards, start with the card(s) you use at the doctor’s office. Then, if you have a separate card you use at the pharmacy, call the number provided on that card.

  • Ask the insurance company representative what your coverage is for ZOSTAVAX.

    If he or she needs a “CPT® code” for the vaccine, the CPT code is 90736.

  • Then, ask the insurance company representative the following questions:

    “What is my cost for ZOSTAVAX?”

    “Do I have a co-pay or any other associated costs? If so, how much?”

 
Co-pay

A fixed amount you pay for a covered health care service, usually when you receive the service. The amount can vary based on the type of insurance and health care service.

Do I have a deductible? If so, have I met the deductible for this year, or how much will I have to pay?”

Is my cost different if I get vaccinated at my doctor’s office or at my pharmacy? If so, how much?”

If you have Medicare Part D, ask about the process for seeking reimbursement and any upfront costs you may have to pay depending on where you are vaccinated.

Insurance coverage, including your out-of-pocket costs, can change over time. Please be sure to confirm the cost at the time you receive the vaccination.

 
Deductible

The amount of money you owe for covered health care services before your health insurance or prescription plan begins to pay.

Helpful Terms

    Out-of-pocket

  • The amount of money (including co-pays and deductible) you pay for health care services.
  • Co-pay

  • A fixed amount you pay for covered health care service, usually when you receive the service. The amount can vary based on the type of insurance and health care service.
  • Deductible

  • The amount of money you owe for covered health care services before your health insurance or prescription plan begins to pay.
  • CPT

  • Current Procedural Terminology
    Copyright® 2014 American Medical Association
    CPT is a registered trademark of the American Medical Association
 

Merck does not warrant or guarantee that ZOSTAVAX is covered by your insurance plan, or that following these steps will result in you or your doctor receiving reimbursement, or that any reimbursement amount you receive will cover your expenses. Merck is not responsible for any action that you or your health care professional take in seeking reimbursement. You or your health care professional should contact your plan directly to ensure that you have the most accurate and timely information on reimbursement, patient out-of-pocket costs, and applicable billing procedures as your coverage status can change.

About ZOSTAVAX

ZOSTAVAX is a vaccine used for adults 50 years of age or older to prevent Shingles (also known as zoster).

Important Safety Information

  • ZOSTAVAX does not protect everyone, so some people who get the vaccine may still get Shingles.
  • You should not get ZOSTAVAX if you are allergic to any of its ingredients, including gelatin or neomycin, have a weakened immune system, take high doses of steroids, or are pregnant or plan to become pregnant. You should not get ZOSTAVAX to prevent chickenpox.
  • Talk to your health care professional if you plan to get ZOSTAVAX at the same time as PNEUMOVAX®23 (Pneumococcal Vaccine Polyvalent) because it may be better to get these vaccines at least 4 weeks apart.
  • Possible side effects include redness, pain, itching, swelling, hard lump, warmth, or bruising at the injection site, as well as headache.
  • ZOSTAVAX contains a weakened chickenpox virus. Tell your health care professional if you will be in close contact with newborn infants, someone who may be pregnant and has not had chickenpox or been vaccinated against chickenpox, or someone who has problems with their immune system. Your health care professional can tell you what situations you may need to avoid.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please read the Patient Information for ZOSTAVAX and discuss it with your health care professional. The physician Prescribing Information also is available.

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