AmeriHealth has expanded its coverage of Shingrix for all members. As of July 26, 2021, the Shingrix vaccine is considered medically necessary for individuals 18 years and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression caused by known disease or therapy. A cost share may apply based on member benefits.
Shingrix is covered as a preventive service for individuals 50 years or older regardless of whether they experienced a prior episode of herpes zoster or received Zostavax vaccine. It is also considered a preventive service for individuals 50 years or older with chronic medical conditions unless their condition constitutes a contraindication.
Please read the Medical Policy Bulletin for background, eligible procedure codes, and links to impacted policies.