MedicaidCoverageMedium impact
Abrysvo™ (Respiratory Syncytial Virus Vaccine) - Seasonal Update
Illinois Medicaid - HFS·IL · OB-GYN, Family Medicine, General Practice +1 more·Provider Notice
Effective date
Dec 20, 2024
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers Abrysvo (RSV vaccine) for pregnant patients 32-36 weeks gestation during September-January season, and year-round for patients 60+. Medical billing requires no prior auth, but pharmacy billing needs physician-submitted prior authorization for pregnant patients.
Action Required
Immediately: Update billing workflows to handle Abrysvo RSV vaccine claims for Illinois Medicaid patients. Medical billing team should process without prior authorization. For pharmacy billing of pregnant patients (32-36 weeks gestation), ensure physician submits prior authorization. Providers must document gestational age, obtain informed consent, and communicate vaccination date to pediatrician and birthing facility. Pregnant patients under 19 must use VFC Program only.