MedicaidPrior AuthMedium impact
Abrysvo™ (Respiratory Syncytial Virus Vaccine) - Update
Illinois Medicaid - HFS·IL · Family Medicine, Internal Medicine, OB-GYN +1 more·Provider Notice
Effective date
Nov 20, 2025
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has removed prior authorization requirements and additional documentation requirements for Abrysvo (RSV vaccine) for individuals 19 years and older, effective November 20, 2025. The vaccine can now be billed through medical and pharmacy channels without prior auth, but providers must still verify eligibility including weeks of gestation for pregnant patients.
Action Required
Immediately: Billing team must update system to remove prior authorization requirements for Abrysvo (RSV vaccine) for Illinois Medicaid patients 19 years and older. Update encounter forms to remind providers they must still verify vaccine eligibility and weeks of gestation for pregnant individuals. Stop requiring additional informed consent documentation beyond standard vaccination methods.