April 2018 

BCBSNM Approves Coverage of New Shingles Vaccine: Shingrix

Blue Cross and Blue Shield of New Mexico (BCBSNM)now covers Shingrix, a new two-dose vaccine approved by the Food and Drug Administration (FDA) in October 2017 for reducing shingles and related nerve pain. 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 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.

BCBSNM covers two doses of Shingrix administered to patients 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 BCBSNM 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 50 and older even if previously vaccinated with Zostavax	Adults 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. Click here for the FDA-approved prescribing information for Shingrix. For more information on patient coverage, contact your BCBSNM representative.
Details on our complete, approved immunization schedule can be found on the BCBSNM Provider page under Standards & Requirements, Clinical Payment and Coding Policies, “Preventive Services Policy CPCP006”.