MedicaidCoverageMedium impact
RSV Prophylaxis – Update #3
Missouri Medicaid (MO HealthNet)·MO · Pediatrics, Family Medicine, Pulmonology·Provider Notice
Effective date
Sep 28, 2021
We identified it
Jun 20, 2026
Summary
MO HealthNet updated RSV prophylaxis coverage effective September 28, 2021, allowing up to 6 doses for eligible participants who meet clinical requirements including age restrictions. This includes 1 dose for October and up to 5 doses during regular RSV season (November-April), with previously approved July-September doses not counting toward the 6-dose limit.
Action Required
Immediately: Billing team must update prior authorization requests for RSV prophylaxis to reflect new 6-dose limit structure. Ensure requests specify timing (October dose vs regular season doses November-April). Contact MO HealthNet at 800-392-8030 for questions about eligibility or approval process.