MedicaidCoverageMedium impact
Abrysvo RSV Vaccine for Pregnant Illinois Medicaid Customers
Illinois Medicaid - HFS·IL · OB-GYN, Family Medicine, Internal Medicine·Provider Notice
Effective date
Dec 8, 2023
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers Abrysvo RSV vaccine for pregnant customers at 32-36 weeks gestational age without prior authorization through medical billing, or with prior authorization through pharmacy billing. Providers must document gestational age, obtain informed consent, and communicate vaccination dates to pediatricians and birthing facilities.
Action Required
Immediately: Update billing workflows to allow Abrysvo RSV vaccine billing for pregnant Illinois Medicaid patients at 32-36 weeks gestation without prior auth via medical billing. Providers must create documentation protocols for gestational age, informed consent forms mentioning pre-eclampsia and pre-term birth risks, and communication procedures to notify pediatricians and birthing facilities of vaccination dates. Under-19 patients must use VFC Program only.