What You Should know About Pneumonia Vaccines

Pneumonia shots are now being marketed directly to consumers, and more than a few patients asked me about getting a second pneumonia vaccine (PCV-13) after they have received the first one.

This newer pneumonia vaccine is often recommended if you have had the first vaccine as it assists the body in different ways. However, confusion comes from whether or not Medicare pays for this second shot, and this is important because it can be quite expensive. The updated recommendations are specific to vaccine type, sequence of vaccination and prior pneumococcal vaccination history should be taken into consideration.

Under certain conditions, Medicare Part B will cover:

1. An initial pneumococcal vaccine to all Medicare beneficiaries who have never received the vaccine under Medicare Part B; and

2. A different, second pneumococcal vaccine one year after the first vaccine was administered (that is, 11 full months have passed following the month in which the last pneumococcal vaccine was administered).

Most of the large national pharmacies are now stocking and administering these vaccines and Medicare does not require that a doctor order the vaccine; therefore, the beneficiary may receive the vaccine upon request without a physician’s order. If you obtain a vaccination at your local Walgreen or CVS, please keep records or have them fax us a copy for your file. We are not keeping the vaccine in stock because it requires special handling, but I am always happy to discuss any questions you may have.