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.
Please note that verification of eligibility and benefits information, and/or the fact that any pre-service review has been conducted, is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered.
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