Reminder for shingles vaccine coverage

Shingles affects 1 in 3 adults in their lifetime, as reported by the Centers for Disease Control and Prevention, and the risk of developing shingles increases with age. To help protect patients over the age of 50, the Shingrix vaccine is recommended as a two-dose series, administered up to 6 months apart.

While most of Point32Health’s members can access the Shingrix vaccine at retail pharmacies, there are some differences across our Harvard Pilgrim and Tufts Health Plan products in how the vaccine can be accessed, which we’ve outlined below.

Tufts Health RITogether

For Tufts Health RITogether members, Shingrix is not covered under the Pharmacy benefit and cannot be accessed at a pharmacy retail clinic, such as CVS MinuteClinic. RITogether members must receive the vaccine under the Medical benefit at a provider location (e.g., office or outpatient clinic). As a provider, you can help your RITogether patients get vaccinated by participating in buy-and-bill or by directing the patient to one of your practice’s outpatient clinics when the vaccine is available.

Commercial and Direct

Harvard Pilgrim Commercial, Tufts Health Plan Commercial, and Tufts Health Direct members age 50 and older can access the Shingrix vaccine under their Medical benefit with no cost-share, either at a participating retail pharmacy or by having it administered at the doctor’s office. You can assist your Commercial and Direct patients by providing them with a list of retail pharmacy locations that administer the vaccine. 

Senior Products/Tufts Health One Care

For members of our Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, and Tufts Health One Care plans, Shingrix is available at retail pharmacies for patients age 50 and older with no cost-share. 

Tufts Health Together

Tufts Health Together members can access the Shingrix vaccine, which is offered under the Pharmacy and Medical benefits, at the doctor’s office or at a retail pharmacy or clinic. For members age 50 and older, the vaccine is available with no cost-share if administered in-network and prior authorization is not required.