Billing elderly for Shingles is unlike billing flu or pneumonia vaccines, which are billed directly to medicare for zero copay. Shingrix is billed to the patients medicare advantage plan (Medicare D). The result of this is usually a high copay. Most Medicare part D plans do not have preventative coverage for vaccines. If the patient has a deductible the vaccine could cost the patient up to $170 per dose. Even if the patient has hit their deductible, or doesn't have one, the patient is still due a brand name copay ranging from $35-$48 per dose. Regardless, sales of Shingrix in the US have been fantastic.