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The New Shingles Vaccine: Cost and ROI Considerations

April 12, 2018

Managed care innovators not only know the market well and are able to offer keen insights. They also surround themselves with experts. Jane Lutz is no exception, so when we asked her about the role PBMs can fulfill as Shingrix (zoster vaccine recombinant, adjuvanted; GlaxoSmithKline), the new shingles vaccine, comes to market, she called on Sharon Glave Frazee, PhD, MPH, PBMI’s VP of research and education, to weigh in.

Dr Frazee’s group modeled out the new vaccine’s uptake, considering several factors (including the prevalence of thos already using the older vaccine, Zostavax [zoster vaccine live; Merck ). Assuming moderate uptake of Shingrix, Dr Frazee and her team estimate the cost to be $4.38 per member, per year in 2018. She said that this cost will go down over time as more people age into Medicare and others will have already been vaccinated. 

“The costs are not zero, but they’re not huge,” she explained. This is especially true, she added, when you consider that an employee with shingles misses an average of 129 hours of work, and can incur significant medical and pharmacy treatment costs. “The potential ROI looks better in that light.”

Dr Frazee noted that PBMs can help employers “make an informed decision about whether or not to include this vaccine under medical or pharmacy benefit.” She admitted that because ROI is tough to quantify, it may be challenging to convince plan sponsors to include it.

But she added: “It is also important to remember that shingles is not an issue that’s going to go away soon. The chicken pox vaccine wasn’t administered routinely until 1996, so until those age 22 and younger become the majority of the workforce, we’re going to be dealing with this.”

—Dean Celia

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