Key takeaways:
Capvaxive is a pneumococcal 21-valent conjugate vaccine approved for use in adults. It helps prevent pneumococcal disease and pneumonia caused by certain types of bacteria. Capvaxive is given as a one-time, single vaccine dose.
Many insurance plans cover recommended vaccines such as Capvaxive with little to no out-of-pocket costs.
Without insurance, Capvaxive costs an average of $379.95 per dose. But how much you pay can depend on the vaccine provider and location. GoodRx discounts and patient assistance programs can reduce the price of Capvaxive.
Save on related medications
Capvaxive is a vaccine used to help protect adults against certain types of pneumococcal disease. It’s recommended for people ages 50 and older, as well as those ages 19 to 49 with certain health conditions or risk factors. Capvaxive protects against 21 different strains of the bacteria Streptococcus pneumoniae, including several not included in other vaccines.
If you don’t have insurance, or your plan doesn’t cover it, you may be wondering how much Capvaxive costs and what your options are. Here’s what you should know about Capvaxive’s cost, coverage, and savings opportunities.
How much does Capvaxive cost?
Without insurance or discounts, Capvaxive costs an average of $379.95 per dose. It’s given as a one-time vaccine, but your total cost can vary depending on where you receive it. If Capvaxive is administered at a pharmacy or medical office, the price may include both the vaccine and a separate administration fee.
What factors affect the cost of Capvaxive?
Several factors can affect how much you pay for Capvaxive:
Insurance coverage: If your plan covers recommended vaccines, you may pay little to nothing. Without coverage, you’re more likely to pay the full cash price.
Where you receive it: Costs can differ among a medical office, pharmacy, or clinic. Some vaccine providers charge separate administration fees.
Billing method: Capvaxive may be billed under your medical or pharmacy benefit, depending on where it’s administered and your insurance plan.
State and local programs: Some public health departments or vaccination programs may offer lower-cost or no-cost options for eligible adults.
Checking your coverage ahead of time and confirming how the vaccine will be billed can help you avoid unexpected costs.
Does insurance cover Capvaxive?
Most health insurance plans cover recommended adult vaccines, such as Capvaxive, with little to no out-of-pocket cost. This includes commercial, Affordable Care Act (ACA) marketplace, and government-funded plans, such as Medicare and Medicaid. Prior authorization requirements aren’t common. If you have Medicare, Capvaxive is covered under Medicare Part B.
Vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) are often covered without cost-sharing under many plans. But it’s still a good idea to confirm your specific coverage.
How different insurance plans cover Capvaxive
The table below breaks down the percentage of enrollees who have coverage for Capvaxive by insurance type. It also shows the likelihood of having prior authorization and step therapy requirements.
Insurance type | Enrollees covered for Capvaxive | Enrollees required to get prior authorization | Enrollees required to do step therapy |
|---|---|---|---|
91.6% | 8.5% | 0% | |
Commercial plans (excluding ACA plans) | 94.5% | 0.3% | 0% |
Medicare (Medicare Advantage and Part D plans)* | 0% | 0% | 0% |
Medicaid, including state-run and managed care plans | 92% | 9.5% | 0% |
*Data does not reflect coverage under Original Medicare (Part B). As mentioned, Capvaxive is covered under Medicare Part B for Medicare beneficiaries.
Source: Managed Markets Insight & Technology, LLC™, as of January 10, 2026 (See methodology below.)
If your insurance doesn’t cover Capvaxive, try these options:
Ask your vaccine provider to verify billing under the correct benefit (medical vs. pharmacy).
Confirm that Capvaxive is recommended for you under CDC or other relevant guidelines (if your plan has this requirement).
Check if your state health department offers vaccination programs.
See if you’re eligible for a patient assistance program, which may provide Capvaxive at no cost.
Ways to save on Capvaxive
Without insurance, Capvaxive can cost several hundred dollars for a dose. But there are savings strategies that can reduce how much you pay. Here are four options to consider.
1. Use a GoodRx coupon
If Capvaxive is available through a participating pharmacy, a GoodRx coupon may help lower the vaccine’s cash price. With a free GoodRx coupon, the price of Capvaxive is as low as $304.14. To use a GoodRx coupon for Capvaxive:
Get a prescription from a healthcare professional.
Search for Capvaxive on the GoodRx website or app.
Choose your preferred pharmacy.
Print, email, or text yourself the coupon.
Show the coupon with your prescription at the pharmacy.
Good to know: Most states allow pharmacists to write or access vaccine prescriptions without having to contact a prescriber. Check with your pharmacy about its requirements.
2. Check if you’re eligible for a patient assistance program
Capvaxive’s manufacturer offers a patient assistance program that provides the vaccine free of charge for people who are uninsured. To be eligible, you must:
Live in the U.S. or a U.S. territory
Be age 19 or older
Not have insurance
Meet annual household income requirements
You can check your eligibility online. If you may qualify, your healthcare professional will help you complete and send the program enrollment form. Call 1-800-293-3881 if you have questions or need assistance.
3. Check with community clinics or public health programs
Some local health departments, community clinics, and federally qualified health centers offer vaccines at a reduced cost based on income. Availability varies by location, so contact your local public health department to see if there are programs available in your area.
4. Tap into your HSA, FSA, or HRA
If you have a health savings account (HSA), flexible spending account (FSA), or health reimbursement arrangement (HRA), you can use those pretax dollars to pay for Capvaxive. Keep your receipts in case documentation is needed to show eligible expenses.
The bottom line
Capvaxive is a pneumococcal vaccine that’s recommended for certain adults. Without insurance or discounts, Capvaxive costs an average of $379.95 per dose. GoodRx discounts and patient assistance programs can reduce how much you pay.
Most insurance plans cover Capvaxive with little to no out-of-pocket cost. Prior authorization requirements are uncommon. But it’s best to check with your specific plan for coverage details to avoid unexpected costs.
Why trust our experts?
Methodology
We obtained national prescription coverage data for each medication from Managed Markets Insight & Technology (MMIT). The data reflects health insurance coverage as of January 10, 2026.
We calculated the percentage of enrollees in plans that cover each medication by dividing the number of enrollees covered for the medication within a specific insurance channel (e.g., ACA, Medicare, Medicaid) by the total number of enrollees in all plans within that channel.
We determined the percentage of enrollees in plans with a prior authorization requirement by calculating the proportion of enrollees in plans that required prior authorization for the medication within each channel.
Finally, we measured the percentage of enrollees in plans with a step therapy requirement by calculating the proportion of enrollees in plans that imposed step therapy requirements for the medication in each channel.
These estimates, derived from national MMIT coverage data, provide insight into health insurance coverage for each medication. They take into account restrictions such as prior authorization, step therapy, and quantity limits. The percentages are expressed relative to the total number of enrollees covered by various insurance channels, including ACA plans, commercial (excluding ACA) plans, Medicare, and Medicaid (both state-run and managed care plans).
References
American Academy of Family Physicians. (2025). Recommended adult immunization schedule for ages 19 years or older.
HRSA Data Warehouse.(n.d.). Find a health center. Health Resources & Services Administration.
Kates, J. (2025). ACIP, CDC, and insurance coverage of vaccines in the United States. KFF.
Medicaid.gov. (n.d.). Managed care. U.S. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Pneumococcal shots. U.S. Centers for Medicare & Medicaid Services.
MerckHelps. (n.d.). Capvaxive (pneumococcal 21-valent conjugate vaccine. Merck.
MerckHelps. (2022). Merck vaccine patient assistance program. Merck.
