Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

April 2018

BCBSTX Approves Coverage of New Shingles Vaccine Shingrix

Blue Cross and Blue Shield of Texas (BCBSTX) now covers Shingrix, a new two-dose vaccine for reducing shingles and related nerve pain that was approved by the Food and Drug Administration (FDA) in October 2017. Until recently, the only vaccine available for shingles was Zostavax®, which is 51 percent effective. Clinical trials show Shingrix is 91 percent effective.

For immunocompetent adults ages 50 and older, the Advisory Committee on Immunization Practices (ACIP) recommends Shingrix over Zostavax. They also recommend that immunocompetent adults who have already had Zostavax also get Shingrix.

BCBSTX covers two doses of Shingrix administered to patients ages 50 and older, even if they have already received Zostavax based on current ACIP recommendations. It is important to check eligibility and benefits information to confirm details regarding copays, coinsurance and deductibles before administering this vaccine to BCBSTX members. 

Vaccine Shingrix Zostavax
Dosage schedule Two doses
(2nd dose 2 - 6 months later)
One dose
Vaccine description Recombinant, adjuvanted Live-attenuated
FDA recommended age Adults ages 50 and older even if previously vaccinated with Zostavax
Adults ages 50 and older
Overall efficacy by year 3* 91% 51%
Administration site Intramuscular
Subcutaneous
CPT® Code 90750 – Zoster (shingles) vaccine, (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection
90736 – Zoster (shingles) vaccine (HZV), live, for subcutaneous injection

*Zostavax and Shingrix prescribing information

For more information on Shingrix, see the Center for Disease Control and Prevention’s Jan. 26, 2018, edition of Morbidity and Mortality Weekly Report. Or see the FDA-approved prescribing information for Shingrix.

Details on our complete, approved immunization schedule can be found on the BCBSTX provider portal under Standards & Requirements, Clinical Payment and Coding Policies, “Preventive Services Policy CPCP006.”

Should you have any further questions, please contact your BCBSTX Network Management Representative.