MedicaidCoverageMedium impact
[Georgia] Newborn RSV Prevention
CareSource·GA · Pediatrics, OB-GYN, Family Medicine·Provider Bulletin
Effective date
Oct 22, 2025
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid clarifies RSV prevention coverage for newborns and pregnant people, including four medication options (Abrysvo, Beyfortus, Enflonsia, and Synagis). Prior authorization is required only for Synagis, which is being discontinued December 31, 2025. Abrysvo, Beyfortus, and Enflonsia are not covered by pharmacy benefit but may be covered medically with no prior auth requirement.
Action Required
By December 31, 2025: Billing and clinical teams must stop submitting claims for Synagis (palivizumab) as CareSource coverage ends this date. Before submitting Synagis claims, obtain prior authorization through both medical and pharmacy channels. For Abrysvo, Beyfortus, and Enflonsia: no prior authorization required for medical claims, but note these are not covered through pharmacy benefit—route through medical claims only. Providers must attest to adequate Synagis stock in office at time of prior auth request to ensure supply through RSV season. Update billing workflows and prior auth submission processes to reflect Synagis discontinuation. Contact Health Partner Services at 1-855-202-1058 (Monday-Friday, 7 a.m.–7 p.m. ET) for clarification on coverage transitions.