Print

Email story

Comment

Email editor

Shingles vaccine a $150 puncture

Experts say too few people have access to the recently approved shot, which can prevent agonizing pain.

By TIMES WIRES
Published September 26, 2006

WASHINGTON - Cornelia Jefferson vividly recalls the excruciating pain that shingles caused her mother and brother. So when her doctor got a supply of the new shingles vaccine, the retiree jumped at the chance - without knowing if her insurance would pay or she would be stuck with a bill for more than $150.

The shingles vaccine called Zostavax was hailed as a way to prevent an agonizing rite of aging when it hit the market last spring.

But with the pricey shots so far going mostly to those who can afford to pay out of pocket, public health specialists fear the vaccine will be vastly underused, and set back broader efforts to increase immunizations for adults.

Shingles is a painful rash caused by the same virus that causes chicken pox and affects more than 1-million U.S. residents each year. At least half those cases happen in people age 60 or older.

More than 38,500 people participated in a study demonstrating the efficacy of the vaccine, including 1,200 Florida residents who got vaccinated at the James A. Haley VA Medical Center in Tampa. It reduced the risk of getting shingles by 51 percent and reduced the pain of the disease by 61 percent.

"I'm overjoyed," Dr. Michael N. Oxman, the study's leader, said in June.

"Being in the age group where my contemporaries are at high risk for (shingles), I'm doubly happy."

Now that the vaccine has been approved, but isn't yet in wide use, some experts are disappointed.

"We have built a Jaguar, and we're going to leave it in the garage," lamented Dr. William Schaffner, a vaccine expert at Vanderbilt University who advises the government on immunization issues.

Topping the concerns: For patients older than 65, Medicare will begin paying for the shingles vaccine in January - but not the way it pays for the most widely used adult inoculations, flu shots, which are fully covered. Instead, the shingles vaccine will be treated like a prescription drug, with varying co-pays depending on a patient's drug plan.

To the dismay of doctors, that also means Medicare won't reimburse them for administering Zostavax, an extra $15 or so they'll have to pass up or charge directly to patients.

Florida is among the six states that don't permit pharmacists to provide immunizations. But in the rest of the country, drugstores have become a leading flu-shot provider. So this fall, pharmacists are being urged to add shingles shots to the menu; they'll get the Medicare reimbursement directly. For many Medicare recipients, a trip to the drugstore might be the simplest way to get Zostavax, said Medicare's Dr. Jeffrey Kelman.

But the shingles vaccine isn't just for those old enough for Medicare. It was approved for sale to people 60 and older. Next month, when the government's vaccine advisers issue the first official guidelines on Zostavax's use, doctors will debate whether those even younger also should be immunized if they're at high risk of shingles.

Most insurers for the under-65 set are awaiting those guidelines before deciding how or whether to cover the shots, according to the trade group America's Health Insurance Plans. The biggest question: Whether the guidelines will say every senior eligible for Zostavax should get it, or just consider getting it.

More than ever before, vaccines aren't just for kids. In addition to Zostavax, whooping cough booster shots were recently recommended for adults up to age 64, and a cervical cancer vaccine hit the market aimed at adolescents and those in their 20s.

These new-generation adult vaccines cost well more than the $10 or $20 for old standbys that protect against the flu or tetanus. Nor is there a national program to guarantee access to immunizations for adults - as there is for children.

The cervical cancer vaccine is the priciest, at more than $300 for a three-shot series, but only a small number of adults qualify for it. Millions are candidates for Zostavax - making the one-dose shingles shot, priced around $150, the big test case to see if doctors can get more adults interested in immunizations.

Merck won't say how many shots it has sold to date. Led by the American Medical Association, doctors groups have begun protesting that Medicare's just-finalized payment plans will limit the number who ultimately offer Zostavax.

It's the law, responded Kelman: Congress set up a provision that allows Medicare recipients free vaccination against flu, pneumonia and in some cases hepatitis, with their doctors paid $15 for each jab to cover time and expenses. But the law makes clear that other vaccines used to prevent disease must be treated as prescription drugs, with no doctor fee, he says.

Information from Times files and the Associated Press was used in this report.

[Last modified September 26, 2006, 00:40:41]