{"id":630916,"date":"2025-01-03T16:43:05","date_gmt":"2025-01-03T21:43:05","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630916"},"modified":"2025-01-03T16:45:30","modified_gmt":"2025-01-03T21:45:30","slug":"does-aetna-cover-gardasil-9","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-aetna-cover-gardasil-9\/","title":{"rendered":"Does Aetna cover Gardasil 9?"},"content":{"rendered":"

Gardasil 9<\/span><\/a> is a vaccine approved by the Food and Drug Administration (FDA) to prevent various medical conditions caused by nine types of <\/span>human papillomavirus (HPV)<\/span><\/a>. According to the Centers for Disease Control and Prevention (CDC), HPV is one of the most common sexually transmitted infections (STIs) that causes genital warts and certain types of cancer, such as cervical cancer, anal cancer, vulvar cancer, throat (oropharyngeal) cancer, and penile cancers that develop from high-risk HPV strains. It is recommended that people ages 9\u201345 get the HPV vaccine.\u00a0<\/span><\/p>\n

\u201cGardasil is preventive, but it does not treat existing <\/span>HPV infections<\/span><\/a> or related conditions,\u201d says Pamela Tambini, MD, a double-board certified physician in internal medicine and addiction medicine, and the medical director at Southeast Detox in Rome, Georgia.\u00a0<\/span><\/p>\n

Dr. Tambini says <\/span>Gardasil 9<\/span><\/a> is covered by most private insurance plans for people up to age 26 as part of preventive care services. \u201cInsurance coverage may vary for adults outside the standard age group,\u201d she explains. \u201cSome plans may cover it if deemed medically necessary.\u201d<\/span><\/p>\n

Gardasil coverage with Aetna<\/span><\/h2>\n

Health insurance plans aren\u2019t one-size-fits-all. There are countless different plans, all with unique drug formularies\u2014medications that the plan will cover. While some health insurance plans may cover certain medical services and prescription medications, others may not. Aetna will cover the HPV-valent vaccine (Gardasil 9) for insureds 9\u201345 years of age as a medically necessary preventive service.<\/span><\/p>\n

However, the insurance company does not consider the Gardasil 9 vaccination medically necessary for people who have completed a three-dose vaccine series with Gardasil or Cervarix. If your healthcare provider does not know or does not have the HPV vaccine product that was previously administered, or is in a setting that is transitioning to Gardasil 9, then the Gardasil 9 vaccine will be considered medically necessary to continue or complete the three-dose series.<\/span><\/p>\n

To check if your Aetna health insurance plan covers preventive services like the Gardasil 9 vaccine series, you can visit the member website at Aetna.com to view your benefit plan.\u00a0<\/span><\/p>\n

How much does Gardasil cost?<\/span><\/h2>\n

The <\/span>average retail price of Gardasil<\/span><\/a> (a single 0.5 mL syringe) is $373 without insurance. You need at least two doses, however, depending on your age and whether you\u2019re immunocompromised. Some people need three doses.\u00a0<\/span><\/p>\n

RELATED: <\/b>Gardasil 9 schedule by age<\/b><\/a><\/p>\n

How much does Gardasil 9 cost with Aetna?<\/span><\/h3>\n

If you have a commercial insurance plan from Aetna, you likely won\u2019t pay anything for Gardasil 9. However, it may ultimately depend on where you get your vaccination. According to <\/span>Merck<\/span><\/a>, the manufacturer of Gardasil, 98.7% of people with commercial insurance pay nothing for the HPV vaccine when they receive it from their healthcare provider, and 92.3% pay nothing for it when they receive it at a pharmacy.<\/span><\/p>\n

If you have an Aetna Medicare or Medicaid plan, you may not have to pay anything for Gardasil either. For example, the <\/span>Aetna Better Health Premier Plan MMAI<\/span><\/a> is a\u00a0<\/span>health plan that contracts with both Medicare and Illinois Medicaid, and it considers Gardasil 9 a Tier 1 drug with a $0 copay. Merck says 96.1% of Medicare beneficiaries pay no out-of-pocket costs for Gardasil 9 when they get the vaccine at their healthcare provider\u2019s office, and 82.9% pay no out-of-pocket costs when they receive it at a pharmacy. The percentage is even higher for people on Medicaid, with at least 99.7% paying nothing for Gardasil whether they receive it at a pharmacy or at a healthcare provider\u2019s office.<\/span><\/p>\n

\u201cIf you\u2019re unsure about coverage, check with your insurance provider or speak with your doctor\u2019s office\u2014they can often help navigate these questions,\u201d Dr. Tambini says.<\/span><\/p>\n

How to save on Gardasil 9<\/span><\/h2>\n

Given that Aetna\u2019s coverage for the HPV vaccine Gardasil 9 can vary depending on different factors and the plan guidelines, there are other ways you can save if your plan doesn\u2019t cover it.\u00a0<\/span><\/p>\n

One way to lower your out-of-pocket costs for the HPV vaccine is by using <\/span>SingleCare<\/span><\/a> to search for Gardasil 9 coupons you can use at a pharmacy near you. Depending on your choice of pharmacy, you could pay $331 instead of $373 per dose of Gardasil 9. Just show your SingleCare prescription discount card to your pharmacist, or show them a printed or digital coupon to get the discount.\u00a0<\/span><\/p>\n

You can use SingleCare even if you have coverage through one of Aetna\u2019s insurance plans, such as if your copay is too expensive or if it doesn\u2019t cover the vaccine.\u00a0<\/span><\/p>\n

Since Gardasil is a recommended and sometimes required vaccination in some states, you may want to check with your state\u2019s public health department to see if you or someone you care for can receive the vaccine free of cost. You can contact your healthcare provider or health department for more details on this preventive service.\u00a0<\/span><\/p>\n

RELATED: <\/b>5 required college vaccines<\/b><\/a><\/p>\n

Dr. Tambini also recommends considering <\/span>Merck\u2019s Patient Assistance Program<\/span><\/a> or the <\/span>Vaccines for Children (VFC) Program<\/span><\/a>, which are opportunities to get the vaccine at reduced or no cost.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Gardasil 9 is a vaccine approved by the Food and Drug Administration (FDA) to prevent various medical conditions caused by nine types of human papillomavirus (HPV). According to the Centers for Disease Control and Prevention (CDC), HPV is one of the most common sexually transmitted infections (STIs) that causes genital warts and certain types of […]<\/p>\n","protected":false},"author":149,"featured_media":630917,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[608,3381,8670],"coauthors":[20975],"class_list":["post-630916","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-health-insurance","tag-vaccines","tag-womens-health","wpautop"],"acf":[],"yoast_head":"\nDoes Aetna cover Gardasil 9?<\/title>\n<meta name=\"description\" content=\"Aetna covers Gardasil 9, the HPV vaccine, but coverage and out-of-pocket costs vary by plan.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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