Zostavax, the Shingles Vaccine, was FDA approved in the spring of 2006 but has not caught on as expected, leaving many people wondering why. A recent study from the Journal of the American Medical Association stated that the vaccine could reduce shingles by 55% so what are the problems with the Zostavax vaccine?
A combination of factors has made the use of Zostavax difficult to spread in the population that would most benefit from it with only about 10% of the eligible 52 million people having received the vaccine.
1. Cost - Merck is charging about $150 for the one-shot vaccine. With physician and hospital mark up, the total bill can come close to $300. In comparison, the standard flu vaccine costs between $11 and $15, and the pneumococcal vaccine, about $25.
2. Medicare & Insurance Coverage Challenges – Zostavax is only approved for people 60 and older, so Medicare coverage is a major issue. Since it would be covered by Medicare Part D, it’s up to each individual Part D prescription plan to decide whether the shingles vaccine should be on its formulary.
3. Pharmacy & Physician Logistical Problems – Zostavax must be stored at a temperature of 5° F (−15° C). Most doctors who see adult patients don’t have a freezer that will keep the vaccine that cold and since Zostavax is prescription only, doctors cannot stock it even if they have the equipment in the office. This leaves patients going to the pharmacy for the vaccine and while some pharmacies administer the shot, ones that don’t can leave patients “brown bagging” the temperature-sensitive vaccine back to the doctor’s office.
4. Supply Issue – Merck — the maker of Zostavax — has reported a shortage of the essential ingredient: live but weakened chickenpox virus. Shortages and the back order warnings of Zostavax were updated by the CDC on January 14, 2011.
5. FDA downplayed the benefits for postherpetic neuralgia – One of the most impressive results from the Shingles Prevention Study that led to approval of the vaccine was the two-thirds reduction in postherpetic neuralgia which for shingles sufferers can be one of the most debilitating aspects of shingles.. But the two-thirds figure — more precisely, 67% — doesn’t appear anywhere in the FDA-approved information about Zostavax.
6. Effectiveness of the Zostavax Vaccine – The vaccine is approved for people 60 and over. The likelihood of getting shingles increases with age. But there’s the rub, because the older you are, the less effective the vaccine is against shingles. It was actually more effective in preventing postherpetic neuralgia in people 70 or older than in those ages 60 to 69.
7. Doctors don’t know about the Vaccine - and if the physicians don’t know about it, the patients don’t know about it. If the insurance companies are not spreading the word (since Medicare is the primary insurance for this population), information about the vaccine is sporadic and sometimes even confusing. Some insurance companies (Kaiser Permanente in California) are not covering the vaccine at all for patients who have already had shingles.
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