Shingles Vaccine Proves Painful

Clara Davidson is refusing to get vaccinated against a recurrence of shingles.
Clara Davidson is refusing to get vaccinated against a recurrence of shingles. (By Susan Biddle -- The Washington Post)
By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, September 25, 2007

Clara Davidson is the kind of person public health officials had in mind when they approved the shingles vaccine last year.

At 83, she recently suffered through a painful bout of shingles, a reactivation of the dormant virus that causes chickenpox. It was, she recalls, "quite nasty," an experience she is eager to avoid repeating. With the possibility of a recurrence in mind, her suburban Maryland internist urged her to get the shot known as Zostavax, which an advisory committee to the federal Centers for Disease Control and Prevention has recommended for Americans 60 and older.

But Davidson's willingness to be immunized evaporated once she discovered the unusual rules governing the vaccine: Medicare won't pay for it, as it does flu shots and other vaccines; her doctor doesn't stock it, so she'd need to pick it up at a pharmacy and bring it back to his office within 30 minutes; and her supplemental Medicare Part D prescription drug plan doesn't cover it.

As a result, the Columbia resident is just saying no to the shot that would cost her $200.

"I can afford to do it, but I got my back up and I'm not going to," said Davidson, who regards her refusal as something of a moral issue. "More people should take a stand; $200 is a horrendous amount of money. The drug companies are rolling in money and should help pay instead of running full-page ads," she said, citing prominent advertisements for the vaccine taken out by manufacturer Merck earlier this year.

Vaccines that are particularly beneficial for older Americans, including those for flu and pneumococcal pneumonia, have been fully covered under traditional Medicare rules. Zostavax is the first vaccine that is -- or isn't -- covered by Medicare Part D drug plans, a byzantine patchwork with a wide variety of rules and reimbursement rates.

"It's become a free-for-all, " said Kenneth Schmader, chief of geriatrics at Duke University Medical Center who heads the research committee for the American Geriatrics Society. While most Part D plans cover Zostavax, he said, some practices are charging as much as $500 per shot (doctors pay about $150 per dose) in an effort to recoup their overhead. Zostavax, which is a live virus, must be handled carefully and remain frozen until shortly before it is injected.

The result, he said, is that many patients who could benefit from the vaccine and avoid shingles and its severely painful aftermath known as postherpetic neuralgia -- nerve damage that can persist for months -- aren't being immunized. Health officials estimate that 35 million to 40 million Americans are candidates for the shot; according to Merck, 1 million doses of the vaccine have been sold.

Merck spokeswoman Mary Elizabeth Blake said that the company "is working to address logistical challenges" confronting patients. "Progress is being made."

"We certainly believe it is priced appropriately and reflects the value of this vaccine," she added.

Most health plans, Aetna included, require that patients pay doctors upfront for the full cost of the vaccine and its administration and then file for reimbursement.

"The amount of reimbursement would depend on the plan a person is in," Aetna spokesman Walt Cherniak said in an e-mail.

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