Provider Notice issued 10/06/2026

Upcoming Respiratory Syncytial Viral (RSV) Season

This notice serves to inform providers of the Department of Healthcare and Family Services’ (HFS) coverage policies on RSV immunizations during the upcoming season. This notice is applicable for both Medicaid fee-for-service (FFS) and Managed Care Organizations (MCOs).

The Department will continue to cover the recommended RSV monoclonal antibodies, Beyfortus (nirsevimab) or Enflonsia (clesrovimb), for infants younger than 8 months of age, who are born during or are entering their first RSV season, October 1 through March 31. IDPH recommends RSV immunization for infants if:

•  Mother did not receive RSV vaccine (Abrysvo) during pregnancy, or
• Mother’s RSV vaccination status is unknown, or
•  Infant was born within 14 days of maternal RSV vaccination.

Enflonsia and Beyfortus are both recommended to be given during the first week of life, preferably before discharge from birthing facility or hospital, for infants born during the RSV season. 

• The Department will continue to cover the recommended RSV monoclonal antibody, Beyfortus (nirsevimab), for children ages 8 months to 19 months who are at increased risk for severe RSV and entering their second RSV season. Enflonsia (clesrovimab) is not approved for this use. The following high-risk children should receive Beyfortus (nirsevimab) just before or early in their second RSV season: 
•  Children born preterm, at earlier than 32 weeks gestation, regardless of the need for medication or other support.
• Children with chronic lung disease attributable to prematurity or to other significant neonatal conditions (e.g., meconium aspiration or congenital diaphragmatic hernia) who required medical support (i.e., chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) at any time during the 6-month period before the start of the second RSV season.
• Children with hemodynamically significant congenital heart disease.
• Children with anatomic pulmonary abnormalities or neuromuscular disorders that put them at risk for severe RSV disease.
•  Children who are severely immunocompromised.
•  Children with Down syndrome or other chromosomal abnormalities placing them at higher risk of severe RSV disease.
•  Children with cystic fibrosis who have either 1) manifestations of severe lung disease (previous hospitalization for pulmonary exacerbation in the first year after birth or abnormalities on chest imaging that persist when stable) or 2) weight-for-length that is less than the 10th percentile.
• American Indian or Alaska Native children. 

The Department will continue to cover the RSV vaccine Abrysvo for pregnant individuals according to the following guidelines:

• The RSV vaccine Abrysvo is FDA-approved and recommended for pregnant individuals only during 32 weeks and 0 days through 36 weeks and 6 days of gestation.
•  Administration should take place September through March 1 per guidance from the Illinois Department of Public Health. 
•  If a pregnant person has received a maternal RSV vaccine during any previous pregnancy, another dose is not recommended during subsequent pregnancies.

For adult RSV vaccinations, Abrysvo, mResvia, and Arexvy will be covered for all patients aged 75 years and older, for patients aged 50-74 years who are at increased risk for severe RSV disease, and for those aged 18 years and older who are immunocompromised according to Infectious Disease Society of America (IDSA) RSV vaccination guidelines. Those previously vaccinated for RSV are not recommended for an additional dose at this time. 

Prior authorization will not be required for these recommended immunizations.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or the applicable MCO.

Laura Phelan, Administrator 
Division of Medical Programs