CommercialPrior AuthMedium impact
23-1466 Protect Your Adult Patients and Patients Who Are Pregnant Against RSV Illness
Health Net·CA · Family Medicine, Internal Medicine, OB-GYN +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net has issued new guidance on RSV vaccine coverage for adults 60+ and pregnant women (32-36 weeks). Prior authorization is required for RSV vaccines in pregnant women but not for adults 60+. The vaccines are covered as preventive care with no out-of-pocket costs.
Action Required
Immediately: Update prior authorization workflow to require pre-approval for RSV vaccines (Abrysvo) administered to pregnant women between 32-36 weeks gestation. No prior authorization needed for adults 60+. Train front desk staff to verify pregnancy status and gestational age before scheduling RSV vaccinations. For PPG providers, refer patients to local pharmacy if RSV vaccine unavailable in office.