MedicaidCoverageMedium impact
Oregon Health Plan coverage of palivizumab for Respiratory Syncytial Virus (RSV) prophylaxis expanded to high-risk children from 12 to 24 months of age, effective immediately
Oregon Health Plan·OR · Pediatrics·Plan
Effective date
Dec 1, 2022
We identified it
Jun 20, 2026
Summary
Oregon Health Plan has expanded palivizumab (RSV prophylaxis) coverage to high-risk children aged 12-24 months, extending the previous age limit of 12 months and younger. This expansion is effective immediately and will last for the duration of the Governor's emergency declaration or the 2022-2023 RSV season, whichever is longer.
Action Required
Immediately: Pediatric providers must inform parents/caregivers of expanded palivizumab eligibility for high-risk children 12-24 months old and request prior authorization through the member's CCO or OHA. For fee-for-service coverage questions, contact Oregon Pharmacy Call Center at 888-202-2126. For CCO coverage, contact the specific CCO directly.