This notice serves to inform providers that Medicaid coverage for the respiratory syncytial virus (RSV) vaccine, Abrysvo, for pregnant customers, 32-36 weeks, will end January 31, 2024, in accordance with the latest Centers for Disease Control (CDC) and Advisory Committee on Immunization Practices (ACIP) guidelines.
To prevent and protect high risk children from RSV at the tail-end of the season, coverage for monoclonal antibodies, Beyfortus (Nirsevimab) and Synagis (Palivizumab), will be continued at least until the end of February this year with plans to reevaluate RSV incidence and hospitalizations before coverage is ended.
Abrysvo or Arexvy will remain available for Medicaid customers aged 60 years and over through the pharmacy point-of-sale and medical billing without a prior authorization.
Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service (FFS) claims or the appropriate managed care organization (MCO).
Also in Illinois, the Department of Health and Family Services will review the following classes for the April 11 Drug and Therapeutics (D and T) Advisory Board meeting:
- Antiasthmatics-Adrenergic Combination Inhalers
- Antiasthmatics-Anticholinergic Inhalers
- Antiasthmatics-Beta Adrenergic Inhalers
- Antiasthmatics-Steroid Inhalers
All clinical and financial submissions are due to the Department by 3:00 pm CST on March 21. Submissions should be sent to: HFS.SupplementalRebaleProgram@illinois.gov.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.