Health & Safety

November 21, 2012

Ask the doc

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99th Medical Group

Q. Does TRICARE pay for the shingles vaccine?

A. Yes. TRICARE covers Zostavax, the vaccine that helps reduce the risk of getting shingles (herpes zoster).

The Centers for Disease Control and Prevention (CDC) recommends a single dose of the vaccine for adults age 60 or older regardless of whether they report a prior episode of shingles (herpes zoster). TRICARE follows the CDC’s recommendations. For more information on the vaccine, please visit FDA’s Questions & Answers on ZostavaxT

TRICARE Pharmacy Program-Applies to All Beneficiaries The shingles vaccine is also covered under the TRICARE pharmacy benefit. There’s no co-pay for the vaccine. Call your local TRICARE network retail pharmacy to make sure it participates in the vaccine program, has the vaccine in stock, and can administer the vaccine. Not every pharmacy is able to administer the shingles vaccine. State laws affect which vaccines can be administered at a pharmacy. To find a network pharmacy near you, call Express Scripts Inc. (ESI) at 1-877-363-1303 or to find a TRICARE network retail pharmacy near you visit ESI’s Pharmacy Locator

Note: TRICARE won’t pay for the shingles vaccine if its purchased at a pharmacy or if your doctor writes you a prescription to buy the shingles vaccine and have it administered at his or her office.

TRICARE Prime Beneficiary: As long as you get your shingles vaccine from your primary care manager, from a network provider, or TRICARE Network retail pharmacy referrals, authorizations, or pre-authorizations from your primary care manager aren’t needed and you won’t be responsible for a deductible or co-pay.

TRICARE Standard/Extra Beneficiary: As long as you get your shingles vaccine from any TRICARE-authorized provider (network or non-network) who obtains and administers the vaccine in his or her office or from a TRICARE Network retail pharmacy; you won’t be responsible for Standard/Extra deductibles and cost shares.

TRICARE For Life Beneficiary: TRICARE will be the primary payer for the vaccine. You may get the shingles vaccine from any TRICARE-authorized provider (network or non-network). Standard/Extra deductibles and cost shares apply. The Standard/Extra cost sharing waiver doesn’t apply to TRICARE beneficiaries who are Medicare-eligible.

Send your questions to askthedoc@nellis.af.mil




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