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Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how
Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how

ABRYSVO PRIOR AUTHORIZATION UPDATE

Date: 02/06/24

Effective February 1, 2024:

Abrysvo is available for members aged 60 years and older through medical and pharmacy billing WITHOUT a prior authorization.

Abrysvo is available through medical billing WITHOUT prior authorization for pregnant members with a gestational age of 32-36 weeks.

Abrysvo is available through pharmacy billing WITH a prior authorization for pregnant members aged 19 years and older with the following requirements:

  • Prescribers will be required to document the gestational age at the time of Abrysvo administration in the pregnant member’s medical records.
  • Prescribers will be required to obtain an informed consent signed by the patient, informing the pregnant patient of the potential benefits to the newborn baby.
  • Prescribers will be required to document in the patient’s medical record and communicate the date of the mother’s vaccination with Abrysvo, with both the pediatrician assigned to care for the newborn baby as well as the birthing center or birthing hospital.
  • The RSV season for Illinois is defined as October 1, 2023-February 29, 2024.

The duration of the Prior Authorization is one time, from September 1, 2023-February 29, 2024.

Please refer to this provider notice for more details.