Clesrovimab-cfor (Enflonsia) (CPB 1088, reviewed 2026-10-09)
Summary
Aetna considers a single intramuscular injection of clesrovimab-cfor (Enflonsia) medically necessary for preventing RSV lower respiratory tract disease in infants younger than 8 months who are born during or entering their first RSV season, when the selection criteria are met. Under those criteria, an infant qualifies when maternal RSV vaccine was not received or its status is unknown, when the infant was born less than 14 days after maternal vaccination, or when the maternal vaccine was received in a prior pregnancy, and the infant has not previously received clesrovimab-cfor, nirsevimab-alip, or palivizumab. The policy also states that an additional dose may be given as soon as an infant undergoing cardiac surgery with cardiopulmonary bypass during or entering the first RSV season is stable after surgery, and Aetna considers all other indications experimental, investigational, or unproven.
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