I recently went in for my annual physical with the same doctor I have been seeing for over 30 years. At the completion of the physical he told me that there was a new shingles vaccine that I should have, even though I had one several years ago. He explained that the new vaccine is essential for seniors and was more effective. There was a catch.
First, the vaccine was in limited supply and wasn’t currently available. Second, it requires two injections 2 to 6 months apart. Third, and most shocking, the vaccine cost of $300 each injection is not covered by Medicare. What the hell?!
(Medicare) Shingles is a common viral infection that causes a painful rash, according to the Mayo Clinic. The Centers for Disease Control and Prevention (CDC) reports that 1 out of every 3 people in the United States will develop shingles (herpes zoster) in their lifetime. The risk of shingles increase with age, with about half of all cases occurring in adults age 60 years old and older.
So, what about the new shingles vaccine Shingrix?
THE MANUFACTURER
Shingrix is manufactured by the London based company GlaxoSmithKline, which enjoyed 2017 after tax profits of $2.1 billion.
(Reuters) - GlaxoSmithKline is facing “unprecedented” demand for its new shingles vaccine Shingrix, suggesting the product could be a bigger money-spinner than the company and analysts initially thought.
Consensus forecasts currently point to peak annual sales for Shingrix of around $2 billion, according to Thomson Reuters data, with the U.S. market the main driver. But this number may prove to be too low, according Exane BNP analysts.
The brokerage reckons sales could rise to $3.9 billion if Shingrix can achieve market penetration rates of around 60 percent - double the level seen with Zostavax (previous shingles vaccine).
MEDICARE
The shingles vaccine falls under Medicare Part D, as a prescription drug, and not as a preventive fully covered under Medicare Part B like the flu and pneumonia vaccines.
(MedShadow) For seniors on a fixed income, getting any shingles vaccine might be a matter of budget over health. A “fair price” for Zostavax is $206, with some pharmacies charging $245, according to HealthcareBluebook.com. The “fair price” for each Shingrix shot is $151, with some pharmacies charging nearly $300 per shot. (emphasis added)
Inclusion in Medicare Part D creates barriers to administration. “For people 65 and older, most doctors don’t even stock the vaccine and can’t be bothered to go through all the rigmarole to bill Medicare for it,” says Dr. Schaffner. Doctors who do stock the vaccine may charge patients upfront, requiring them to get reimbursed by their insurance provider.
CONGRESS
(MedShadow) Efforts to get Congress to move other ACIP-recommended vaccines, including the shingles vaccine, to Medicare Part B, have gone nowhere fast, he says. “No one has any optimism in the current political environment that we’re going to get that. The dominant theme is to tear down the Affordable Care Act, so they’re not going to start expanding preventive health services.”
It appears like everything is lined up so everyone in the pipeline is taken care of - except seniors.
GlaxoSmithKline stands to make exorbitant profits on Shingrix. The first step in maximizing profit is to be a singular supplier. The second step in creating a demand for the vaccine is to be in control of supply. The third step is to promote and it won’t be long until we will see advertising. Once again profit overshadows the public good.
As it goes through the pipeline, everyone takes their cut. The determined fair price for Shingrix is $151. By the time it reaches the doctor or pharmacy, who likely take a cut, the cost is $300. Congress has refused to make Shingrix covered under Medicare Part B. Rather than negotiate a realistic price from the manufacturer and cover the cost of Shingrix in Medicare, Congress would rather pay much more in medical costs when someone gets shingles.
Shingrix appears to be essential for seniors. A retired couple on fixed income or social security alone will likely have to pay $1200 for the injections. More probable is that they will not get the injections because of cost, leaving it to Medicare or Medicaid to pay more later when they get shingles.
But why make any changes now when there are huge profits to be made?
Just one day more…
