Provider Notice issued 10/30/2024

This notice confirms to 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 (nirsevimab) immunization through the VFC program. Beyfortus is indicated for neonates and infants younger than 8 months of age who were born during or are entering their first RSV season (usually November 1 until March 31) and for children 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.

Per the American Academy of Pediatrics (AAP): Beyfortus was approved by the United States Food and Drug Administration (FDA) on July 17, 2023. Beyfortus is a long-acting monoclonal antibody product intended for use in neonates and infants to protect against (medically attended) respiratory syncytial virus (RSV) disease. Beyfortus is preferred over Synagis (palivizumab) because of its efficacy, duration, and convenience.

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. Based on the RSV seasonal occurrence reported in Illinois communities this year, and data reported by the Illinois Department of Public Health (IDPH), and the Centers for Disease Control and Prevention (CDC), HFS will follow the previously adopted (pre-pandemic) schedule for Synagis, making it available November 1, 2024, through March 31, 2025.

Per CDC guidelines, except in rare circumstances, most infants younger than 6 months of age do not need Beyfortus or Synagis 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 or Synagis is administered to an infant.   

The following links may prove helpful to providers:

·         AAP Recommendations for the Prevention of RSV Disease in Infants and Children

o   https://publications.aap.org/redbook/resources/25379/AAP-Recommendations-for-the-Prevention-of-RSV?autologincheck=redirected

·         CDC MMWR: Use of Nirsevimab for the Prevention of RSV Disease Among Infants and Children

o   https://www.cdc.gov/mmwr/volumes/72/wr/mm7234a4.htm

·         IDPH’s Illinois VFC Provider Search Tool

o   http://vfc.illinois.gov/search/

·         HFS Provider Notice Issued 12/08/2023 Regarding Abrysvo RSV Vaccine

o   https://hfs.illinois.gov/medicalproviders/notices/notice.prn231208a.html

·         HFS Provider Notice Issued 12/08/2023 Regarding Beyfortus RSV Vaccine

https://hfs.illinois.gov/medicalproviders/notices/notice.prn231208b.html

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