New Medicine for RSV Prevention in Infants - Beyfortus

Date: 09/27/23

In July 2023, the Food and Drug Administration (FDA) approved Nirsevimab (Beyfortus™), a single-dose monoclonal antibody, for the prevention of Respiratory Syncytial Virus (RSV) in infants. In August 2023, Advisory Committee on Immunization Practices (ACIP) recommended Beyfortus™ be added to the Texas Vaccines for Children (TVFC) program.

As a result, the Texas Medicaid and Children’s Health Insurance Program (CHIP) Services Office of Medical Directors is encouraging providers to educate patients and enroll in TVFC to help ensure eligible infants have access to this new preventive treatment.

Superior HealthPlan will follow state guidance on coverage of Beyfortus™.

Key Facts About Beyfortus™:

• It is a monoclonal antibody for the prevention of RSV infection in all infants, aged 0-8 months during or upon entering their first RSV season and again for certain high-risk babies entering their second RSV season.
• It is given as a single intramuscular injection to protect infants through a typical 5-month RSV season.
• For babies born during the RSV season, Beyfortus™ should be administered in the newborn nursery or soon after discharge to decrease the risk of RSV infection.
• For babies born during the off-season, Beyfortus™ can be administered at a primary care provider office at the beginning of RSV season.
• Since Beyfortus™ will be available through the TVFC program, Superior will not reimburse for the vaccine. However, administration fees are a covered benefit and therefore, eligible for reimbursement. Timely filing deadlines, clean claim guidelines and standard claim processing times apply.

For questions, please contact your local Account Manager.