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Elizabeth M. Whitehorn, Director

Provider Notice issued 02/02/2024

 

To: Enrolled Physicians; Advanced Practice Nurses: Physician Assistants; Local Health Departments; Hospitals; Federally Qualified Health Centers; Rural Health Clinics; Encounter Rate Clinics; and Pharmacies
​Date: ​February 2, 2024
​Re: Abrysvo (RSV Vaccine) for Pregnant Illinois Medicaid Customers and Arexvy (RSV Vaccine) Updates

This notice serves to inform providers that Illinois Medicaid coverage for the respiratory syncytial virus (RSV) vaccine, Abrysvo, for pregnant customers, 32-36 weeks, will end January 31, 2024, in accordance with the latest Centers for Disease Control (CDC) and Advisory Committee on Immunization Practices (ACIP) guidelines.

To prevent and protect high risk children from RSV at the tail-end of the season, coverage for monoclonal antibodies, Beyfortus (Nirsevimab) and Synagis (Palivizumab), will be continued at least until the end of February this year with plans to reevaluate RSV incidence and hospitalizations before coverage is ended.

Abrysvo or Arexvy will remain available for Illinois Medicaid customers aged 60 and over through the pharmacy point-of-sale and medical billing without a prior authorization.

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

 

Kelly Cunningham, Administrator
Division of Medical Programs