FNHA announces better access to shingles vaccine coverage

Denise Titian, February 19, 2020

The First Nations Health Authority has expanded benefits to cover an expensive shingles vaccine. (FNHA photo)

British Columbia — 

Shingrix, the medication that helps prevent the painful viral affliction called shingles, is now available to seniors ages 65 to 69 with out of pocket expenses. This means that FNHA clients age 65 to 69 can receive the vaccine from a licensed pharmacist without having to pay up front and send in receipts for reimbursement.  

Shingles, also known as herpes zoster, is a painful, blistering rash caused by the vari-cella zoster virus – the virus that causes chicken pox. Anyone that has ever had chicken pox can potentially develop shingles, however it is more common – and more likely to cause complications and long-term effects – in older people.

Pain from the shingles rash can last for weeks and even months.

Previously, First Nations Health Authority (FNHA) clients in this age group were eligible for coverage but only through reimbursement.

Sheila Hill, an Ahousaht member living in Vancouver, is not only a FNHA client, but has worked for the health authority and its predecessor for more than 30 years. In her mid-50s, Hill said she received many calls from clients complaining about the fact that the Shingrix vaccine was not covered and was very expensive.

“We always told them to send their complaint in to us in writing, because they can’t do anything to make it better if they don’t know about it,” said Hill.

Concerned that she may be at risk for shingles, Hill paid $300 for her Shingrix vaccination two years ago. She didn’t follow up with the recommended second dose because nobody told her about it. She was diagnosed with shingles on Feb. 13.

It was on that same day, Feb. 13, that the FNHA announced that Shingrix Vaccine is now listed by Pacific Blue Cross for clients between the ages of 65 and 69. Pharmacists can bill PBC directly for the medication.

FNHA says the 65 – 69 group was selected for the benefit coverage because the vaccine has a high impact on this age group.

“People in this age group are more likely to get shingles and have higher rates of hospitalization from it,” stated the FNHA.

The vaccine requires two doses to be fully effective. FNHA clients who received their first dose through the reimbursement process will be eligible for direct payment to cover their second dose.

“Those clients outside of this age group can work with their doctor to go as a case-by-case basis and apply for Special Authority to get this product covered by exception through FNHA Vancouver,” said Sally Kwan, the FNHA’s Pharmacy Assessor – Health Benefits, in an email.

For Hill, it appears that her initial investment of $300 for the Shingles Vaccine was not a waste. She was prescribed medication to treat the rash and less than a week later the rash is gone. She is following up with her physician for advice about how to move forward with another shingles vaccination.

“We are pleased we can respond to feedback and now offer direct payment to pharmacies for Shingrix, which has a 90 per cent effectiveness rate," said Dr. Evan Adams, the FNHA's Chief Medical Officer.

Clients eligible for coverage are limited to two Shingrix Vaccine units per lifetime. The change in benefits came into effect Feb. 12, 2020.

The FNHA invites clients with questions about their health benefits coverage to visit www.fnha.ca/benefits or call First Nations Health Benefits at 1-855-550-5454.