MedicaidPrior AuthMedium impact
[Indiana] Newborn RSV Prevention
CareSource·IN · Pediatrics, OB-GYN, Family Medicine +1 more·Provider Bulletin
We identified it
May 9, 2026
Summary
CareSource Indiana Medicaid issued a provider bulletin reminding of RSV prevention options for newborns and pregnant people. Key coverage clarification: Abrysvo (vaccine for pregnant people at 32-36 weeks) requires no prior authorization; Beyfortus (Nirsevimab antibody for newborns) is not covered; Synagis (Palivizumab antibody) requires medical prior authorization for physician billing only and pharmacy prior authorization. If mother received Abrysvo during pregnancy, newborn does not need antibody treatment.
Action Required
Immediately: Billing team must update system to reflect correct prior authorization requirements for RSV products under Indiana Medicaid. For Synagis (Palivizumab): require medical prior authorization when billed by physicians; mark as not covered when billed from facility/hospital; require pharmacy prior authorization for pharmacy dispensing. For Beyfortus (Nirsevimab): flag as not covered under Indiana Medicaid and do not submit claims. For Abrysvo: no prior authorization required unless VFC provider status applies. Update claim submission protocols and staff training materials. Contact Health Partner Services at 1-855-607-2831 (Mon-Fri, 7am-7pm CT) for authorization questions. Failure to obtain required prior authorization for Synagis will result in claim denials.