Vaccinations: A Review & Lessons Learned

What a process just getting vaccines for this trip has been and hindsight is 20/20.

When we decided that we were going to go on this trip I began researching which vaccines were required and which were recommended by the CDC. I compiled a list of 11 vaccines (see list below) and took the list to an appointment to review with our doctor.

original list of recommended/required vaccines:

  1. MMR (Measles, Mumps, & Rubella)
  2. TDaP (Tetanus, Diphtheria, & Pertussis)
  3. Varicella (Chickenpox)
  4. Polio
  5. Flu Shot
  6. Hepatitis A
  7. Typhoid*
  8. Hepatitis B
  9. Malaria†*
  10. Rabies*
  11. Yellow Fever†*

We discussed the list, talked about the reason for doing each vaccine and managed to cut the list down to 7. By the end of the appointment we had cut the list down to the following:

  1. MMR (Measles, Mumps, & Rubella)
  2. TDaP (Tetanus, Diphtheria, & Pertussis)
  3. Hepatitis A
  4. Typhoid*
  5. Malaria†*
  6. Rabies*
  7. Yellow Fever†*

We cut the varicella (chickenpox) vaccine because both Steve & I had chickenpox as children. We cut the polio vaccine because we were vaccinated as children. Neither Steve or I have ever received a flu shot or are big fans of the flu shot so we cut that one from the list. Hepatitis B got cut from the list because we aren’t planning on having sex with anyone else, getting tattoos or piercings, or having any medical procedures while traveling.

We also learned that our doctor’s office does not administer vaccines and that we would need to go to a pharmacy or a travel clinic to get them. Our doctor mentioned that we could try the Walgreens where we normally get our prescriptions filled.

So, at this point, off we went to our usual Walgreens and found that yes they would administer vaccines, except yellow fever. We had our first vaccine, TDap, administered at Walgreens on 08/22/2016. Originally they tried processing the claim through our prescription insurance and it was denied so we paid for it out-of-pocket. It didn’t occur to either Steve or I at the time that vaccines would be covered under our major medical insurance nor did anyone at Walgreens offer that they could bill our major medical insurance. In searching for a place that would administer the yellow fever vaccine I discovered that Costco’s pharmacy (one of our favorite stores to shop at) would do all the vaccines we were looking for and for about 60% of what it was going to cost us at Walgreens. So, we switched to having our vaccines done at Costco since we thought we were going to be paying for them out-of-pocket. Some of the vaccines require a prescription from your doctor before the pharmacy will administer them: yellow fever, rabies, and malaria in our case. One of the pharmacies had mentioned that if there is a prescription it might be covered by your prescription coverage. So, Steve called our prescription insurance to find out if they would cover any of the vaccines. They would not but they recommended that we call our major medical (health) insurance to see if they would cover them. So, Steve called our major medical insurance to find out not only would they cover most of them but that his company pays for premium travel vaccine coverage so they would be covered 100%. Thank you God! The only vaccines our major medical would not cover were malaria and rabies. Initially we were told at Costco that a 6 month supply of malaria medication would be about $1,000 per person and that the rabies vaccine would be $1,111.50 per person. These two figures and the desire to limit the number of vaccines we would be dumping in my body triggered us to do a ton of research to determine the necessity of these two vaccines. We decided that the malaria (medication) vaccine would be necessary, read more in our post “Vaccinations Week 6: Malaria“, even though there is only risk of malaria in select areas of Peru, Ecuador, Colombia, and Panama. There is currently not a vaccine for malaria so you have to take medication to prevent malaria. Since the malaria medication is a prescription drug our prescription insurance covered it. We decided to forgo the rabies vaccine, you can read more about that in our post, “Vaccinations Week 7: Hepatitis A, Rabies, & MMR“, saving us $1,111.50 per person. At the end of it all we ended up having Costco administer: hepatitis A, yellow fever, and typhoid. We got the malaria medication directly from our prescription insurance company. We had Walgreens administer TDaP (tetanus, diphtheria, & pertussis) and MMR (measles, mumps, & rubella).

Recap so far:
prices below are per person before insurance

  1. TDaP (Tetanus, Diphtheria, & Pertussis) $64 08/22/2016
  2. MMR (Measles, Mumps, & Rubella) $99.99 10/07/2016
  3. Hepatitis A (Round 1)  $71.09 08/29/2016
  4. Hepatitis A (Round 2) $71.09
  5. Malaria* (6 month supply) $162.14
  6. Typhoid* (Oral, every other day for 7 days) $63.34 09/14/2016 – 09/20/2016
  7. Yellow Fever* $159.09 09/06/2016

Total before insurance $619.65 so far. We still need to get one more round of hepatitis A after we get back from Latin America.

We paid out-of-pocket to Walgreens for the TDaP (tetanus, diphtheria, & pertussis), to Costco for the hepatitis A, yellow fever, and typhoid and then had to submit the charges to our insurance company to be reimbursed. Getting the vaccines reimbursed was a hassle. It took at least 4 phone calls to our insurance company to straighten out. We got the best price and a vacation override so we could get all 180 days of the malaria medication upfront directly through our prescription insurance company. In going back and forth with our major medical insurance company we learned that we could go to Walgreens and have them bill our major medical insurance for the vaccines and not have to pay out-of-pocket so we had the MMR (measles, mumps, & rubella) vaccine done at Walgreens and had them bill our major medical, easy-peasy our major medical paid Walgreens directly.

Lessons we have learned

  1. Get started early. The minimum amount of time you will need is 4-6 weeks. We started the process 8 weeks before our departure date. If you want to stagger your vaccines like we did (1 week apart) or even further you will need a fair amount of time. Honestly, I don’t think it would be a bad idea to start the process 6 months before leaving.
  2. Know which vaccines are required for the areas you will be traveling to. Good resources for getting this information: CDC, U.S. Department of State, World Health Organization, and IAMAT.
  3. Consult with your doctor to determine which vaccines you should get given your travel itinerary and your health.
  4. Know how many rounds each vaccine is and on what schedule you should have them administered. Vaccine specific information can be found on the CDC site or at State or City Public Health websites. You can also find this out at a local pharmacy that administers vaccines.
  5. Check with both your prescription and major medical (health) insurance to see what will be covered. If one or both of them will cover vaccines ask for a list of in-network pharmacies and/or travel clinics that will bill your insurance directly.
  6. I would encourage you to find a single facility that will administer the vaccines and write prescriptions for the medications you will need. Make sure they will bill your insurance directly and that you won’t have to pay them out-of-pocket and then submit the expense to your insurance company for reimbursement.

Recap after insurance:
prices below are per person after insurance

  1. TDaP (Tetanus, Diphtheria, & Pertussis) $0 08/22/2016
  2. MMR (Measles, Mumps, & Rubella) $0 10/07/2016
  3. Hepatitis A (Round 1)  $0 08/29/2016
  4. Hepatitis A (Round 2) $71.09 – To be paid when we get the vaccine upon return to the US.
  5. Malaria* (6 month supply) $94.08
  6. Typhoid* (Oral, every other day for 7 days) $0 09/14/2016 – 09/20/2016
  7. Yellow Fever* $0 09/06/2016

Total after insurance $94.08 so far. We still need to get one more round of hepatitis A after we get back from Latin America. We plan on getting the last round of hepatitis A administered at Walgreens because they will bill our major medical insurance directly.

† required vaccines because of the areas we will/might be traveling to.
* prescription required.

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