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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/08/2023

 

Date: December 8, 2023
​To: Enrolled Physicians; Advanced Practice Nurses: Physician Assistants; Local Health Departments; Hospitals; Federally Qualified Health Centers; Rural Health Clinics; Encounter Rate Clinics; and Pharmacies

​Re:

 

Beyfortus (nirsevimab-alip) RSV Vaccine

 

This notice informs providers that the Department of Healthcare and Family Services (HFS) allows an administration fee for Vaccine for Children (VFC) Program-enrolled providers who obtain Beyfortus immunization through the VFC program for neonates and infants. Children eligible for this vaccine are those younger than 8 months of age who were born during or are entering their first RSV season (usually November 1 until March 31) and ages 8 through 19 months who remain vulnerable to severe RSV disease through their second RSV season. 

An administration fee is available only for Beyfortus obtained via the VFC program, not if obtained through pharmacy point-of-sale or medical billing. Hospitals and non-institutional providers are encouraged to enroll in the VFC program to ensure access to Beyfortus for Medicaid and CHIP-enrolled children and qualify for the allowable administration fee.

Note: If Beyfortus is not available through the VFC program due to supply chain issues, providers may request Synagis if the infant meets those criteria.

Per the Centers for Disease Control (CDC) guidelines, except in rare circumstances, most infants younger than 8 months of age do not need Beyfortus if they were born 14 or more days after the mother received the Abrysvo RSV vaccine during 32-36 weeks of pregnancy. The providers of care to infants and their mothers are advised to communicate timely and document in their medical records if the mother received or did not receive Abrysvo during pregnancy, before Beyfortus is administered to an infant.   

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate MCO.

 

 

Kelly Cunningham, Administrator
Division of Medical Programs