Understanding RSV and Arexvy Vaccine Coverage
Respiratory syncytial virus (RSV) is a common infection of the lungs and breathing passages that causes cold-like symptoms. According to the Centers for Disease Control and Prevention (CDC), RSV causes 60,000–160,000 hospitalizations and 6,000–10,000 deaths among people ages 65 and older each year. The Food and Drug Administration (FDA) states that Arexvy, an RSV vaccine, can reduce the risk of developing RSV-related lower respiratory tract disease by 94.1%.
Cost of Arexvy
Manufactured by GSK, the average retail price of Arexvy is $630.16 per dose. The actual price may vary depending on your insurance coverage and where you receive the vaccine. Medicare Part D often covers Arexvy for older adults, but this varies between plans and patients.
Does Medicare Cover Arexvy?
In most cases, yes. Medicare Part D or Medicare Advantage plans with Part D coverage must cover these vaccines. According to the Centers for Medicare and Medicaid Services (CMS), Part D beneficiaries usually pay nothing out of pocket for most vaccines, including the RSV shot. Thanks to the Inflation Reduction Act, patients will pay $0 out of pocket.
However, this only applies to those with Medicare Part D plans. Medicare Part A does not cover drugs, and although Part B covers some vaccines, Arexvy is not included. Medicare Advantage plans (Part C) often include drug coverage, so check with your specific plan.
Factors Influencing Medicare Coverage of Arexvy
Medicare Part D typically covers all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including RSV, shingles, and hepatitis vaccines. The Inflation Reduction Act of 2022 made vaccines covered by Part D free to Medicare beneficiaries, similar to those covered by Medicare Part B. This means you do not have to pay toward your deductible, the cost of the vaccine, or any dispensing or administrative fees.
However, some plans might not include Arexvy on their formularies. If the vaccine is not on your plan’s formulary, you might need to pay upfront and then seek reimbursement. Certain plans might require prior authorization—additional paperwork from your healthcare provider about the medication’s necessity.
Cost of Arexvy Without Insurance
On average, Arexvy costs $630 without any insurance coverage or discounts. However, prices can vary based on factors like inflation, manufacturer policies, and pharmacy location. Even though most people with Medicare coverage won’t need to pay for Arexvy, private insurance plans may have cost-sharing policies.
Alternative Options if Medicare Doesn’t Cover Arexvy
Sign Up for Arexvy Coupons:
- You can use prescription discount cards, which provide discounts on thousands of medications, including Arexvy. Although these cannot be combined with Medicare or insurance, they can still offer significant savings.
Apply for Medicaid:
- If you have Medicare and meet certain financial requirements, you might also be eligible for Medicaid. Medicaid can help cover the cost of drugs not fully covered by Medicare.
Look Into Other Government and Nonprofit Assistance:
- Nonprofit organizations like the Patient Advocate Foundation and the PAN Foundation offer grants to help pay for prescription drugs.
Consider an HSA or FSA:
- Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) allow individuals to use pretax dollars to cover out-of-pocket expenses, including vaccines not fully covered by Medicare or other insurance plans.
Ask About Alternatives:
- The only FDA-approved alternative to Arexvy is Pfizer’s Abrysvo. Consult a healthcare provider to compare prices and determine which vaccine is better for you.
Locate Less Expensive Pharmacy Options:
- Since pharmacy prices can vary, calling around to different pharmacies might help you find lower prices.
Conclusion
Understanding RSV and the Arexvy vaccine coverage is crucial for managing your health. For personalized assistance with Medicare Part D or other health insurance plans, contact us at 833-739-1122. We simplify your health insurance search by comparing top plans to find the best, affordable coverage suited just for you. Picking the wrong health insurance policy can cost you, and the best options are usually not advertised. With millions enrolled in Medicare and ACA, personalized coverage is crucial not just to your wallet but to your health. Let us navigate the complex options to find the best plan for you.
