Please be aware of the coverage and authorization requirements for the following prevention products:

Abrysvo (respiratory syncytial virus vaccine recombinant)

An RSV vaccine given as a single dose during weeks 32 through 36 of pregnancy to protect infants from RSV infection.

Abrysvo does not require prior authorization.

Arexvy®

An RSV vaccine given as a single dose to prevent RSV infection in persons age 60 years and older.

Arexvy does not require prior authorization for persons 60 years of age and older.

Beyfortus® (nirsevimab)

A long-acting antibody given as a single dose to prevent RSV infection in young children. Note: Due to the limited supply, the CDC recommends prioritizing nirsevimab for infants at the highest risk for severe RSV disease (i.e., young infants [less than six months of age] and infants with underlying conditions that place them at highest risk for severe RSV disease).

• Children under six months of age – no prior authorization required.
• Children six months through 18 months of age – prior authorization required to ensure medical necessity.
• Children 19 months of age and older – not covered.

Synagis® (palivizumab)

This is an antibody given monthly by IM injection to children less than 24 months of age with underlying conditions that place them at high risk for severe RSV disease.

Synagis is a specialty medication that requires a copayment. RSV vaccines, when administered as recommended (including prior authorization when required) are covered as a preventive benefit with no out-of-pocket costs for members.

Synagis does require prior authorization.