Respiratory Syncytial Virus (RSV) Notice
The Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practice (ACIP) issued an update and new recommendations in July 2024 about vaccination and immunization best practices for Respiratory Syncytial Virus (RSV) in adults, pregnant people, infants, and young children which can be viewed on the CDC website.
RSV immunization recommendations and updates for 2024 summary:
- CDC recommends an RSV vaccine for all adults ages 75 and older.
- CDC recommends an RSV vaccine for adults ages 60-74 at increased risk of severe RSV. Risk factors for severe RSV in adults 60-74 years and older include chronic cardiovascular disease, chronic lung or respiratory disease, and others, a complete list of risk factors can be found here.
- RSV vaccination is recommended as a single lifetime dose only. Persons who have already received RSV vaccination are NOT recommended to receive another dose.
- The best time to get vaccinated is in late summer and early fall — just before RSV usually starts to spread in the community.
- To prevent severe RSV disease in infants, CDC recommends either maternal RSV vaccination or infant immunization with RSV monoclonal antibodies. Most infants will not need both.
- For pregnant people:
- CDC recommends 1 dose of Abrysvo® during weeks 32 through 36 of pregnancy, administered September through January.
- Abrysvo® is the only RSV vaccine recommended during pregnancy.
- For infants and young children
- CDC recommends 1 dose of Beyfortus® for all infants ages less than 8 months born during or entering their first RSV season
- CDC recommends 1 dose of Beyfortus® for infants and children ages 8–19 months who are at increased risk for severe RSV disease and entering their second RSV season.
Available RSV vaccines – Brand name, generic name, (Manufacturer)
- Abrysvo®, Recombinant Injection RSV Vaccine. (Pfizer)
- Arexvy®, Recombinant [Adjuvanted] Injection RSV Vaccine, (GlaxoSmithKline)
- mResvia®, mRNA Injection RSV Vaccine, (Moderna)
Available RSV monoclonal antibodies – Brand name, generic name, (Manufacturer)
- Synagis®, palivizumab, (Sobi)
- Beyfortus®, nirsevimab-alip, (Sanofi)
Meridian Michigan Medicaid covers RSV vaccines and monoclonal antibodies under both pharmacy and medical benefits. Some products will require a prior authorization. Please refer to the following chart to identify coverage restrictions. You can contact provider services at phone number 888-773-2647, and our pharmacy help desk at phone number 866-984-6462.
Product Name | Dosing schedule | Medical Benefits Coverage and Restrictions – MI Meridian Medicaid | Pharmacy Benefits Coverage and Restrictions – MI Meridian Medicaid |
|---|---|---|---|
Abrysvo® | Single dose per lifetime | Covered ; CPT code 90678 ; No prior authorization required under medical benefit | Covered ; No prior authorization required ; Age Limit applies, member must be 60 years or older |
Arexvy® | Single dose per lifetime | Covered ; CPT code 90679 ; No prior authorization required under medical benefit | Covered ; No prior authorization required |
mResvia® | Single dose per lifetime | Covered ; CPT code 90683 ; No prior authorization required under medical benefit | Not covered ; Not on pharmacy benefit formulary |
*Synagis® | Up to 5 doses per RSV season | Covered ; CPT code 90378 ; Prior authorization required under medical benefits | Covered; Prior authorization required |
**Beyfortus® | Single dose per RSV season (2 doses for surgeries planned cardiopulmonary bypass) | Covered ; CPT codes 90380 (0.5mL dose) and 90381 (0.1mL dose) ; No prior authorization required under medical benefits | Covered; Prior authorization required |
*Prior authorization for Synagis® is required under both medical benefits and pharmacy benefits.
**Prior authorization for Beyfortus® is required under pharmacy benefits.
Synagis® and Beyfortus® pharmacy benefit prior authorization (PA) criteria can be found on the State of Michigan’s website here by clicking the link for “Drug PA Criteria” or access the state’s PA criteria directly here.