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RSV Prophylaxis

Missouri Medicaid (MO HealthNet)·MO · Pediatrics, Pulmonology, Family Medicine·Provider Notice
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Days to comply
—

Summary

Missouri Medicaid will begin reviewing RSV prophylaxis (palivizumab) prior authorization requests starting September 1, 2022, due to increasing RSV activity in Missouri regions. Eligible infants can receive up to 5 doses for the 2022-2023 season, with recommendations for monthly single-dose ordering to reduce waste.

Action Required

Action needed
By September 1, 2022: Billing team must coordinate with providers to ensure RSV prophylaxis (palivizumab) requests include proper prior authorization for Missouri Medicaid patients. Pharmacies should confirm scheduled patient appointments before dispensing to reduce waste. Consider ordering single monthly doses rather than full 5-dose supplies. Monitor for potential early season termination notifications from MHD.

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