Encourage Protection from Respiratory Syncytial Virus (RSV)

Help us educate our members, your patients, about the RSV vaccine.

RSV¹ usually causes mild symptoms, but in some cases, it can cause severe illness. It is one of the most common causes of hospitalizations among infants, some young children, people with compromised immune systems, and older adults. Many of our Highmark Wholecare members fall into these groups of patients and may be at a greater risk of complications. The CDC recommends vaccination during the RSV season, which usually starts in the fall and peaks in the winter.

The RSV vaccines listed below are covered at a pharmacy. Administration outside of the Advisory Committee on Immunization Practices (ACIP) guidelines requires a prescription and a prior authorization or drug exception.

For Medicare, these vaccines are covered under Part D. Refer to the CMS website to learn about administration at a provider’s office and more².

RSV Vaccination Guidelines per the ACIP

According to the guidelines³:

• Individuals 75 years and older should receive the RSV vaccine.
• Some individuals ages 60-74 who are at increased risk for severe RSV should receive the vaccine (cardiovascular disease, chronic obstructive pulmonary disease, asthma, cystic fibrosis, chronic kidney disease-dialysis, cirrhosis, diabetes mellitus, impaired airway clearance, chronic hematologic disease-sickle cell, immunocompromised, severe obesity, residence in nursing home).
• To protect infants from severe RSV, either maternal RSV vaccination or infant immunization with the RSV monoclonal antibody (nirsevimab) is recommended. Most infants will not need both.

This is not an annual vaccine—studies do not show enhanced protection with second dose. Individuals can receive RSV, flu, and covid vaccines at that the same time.

Different Vaccines and Antibodies:

Arexvy (GSK) RSV vaccine- approved for patients ages 50 and older who are at an increased risk and per ACIP guidelines.

Abrysvo (Pfizer) RSV vaccine- approved for patients ages 60 and older who are at an increased risk and per ACIP guidelines. Additionally, for pregnant individuals at 32-36 weeks gestation only during September through January. No ACIP recommendations for subsequent pregnancies.

MResvia (Moderna) mRNA RSV vaccine- approved for patients ages 60 and older who are at an increased risk and per ACIP guidelines.

Beyfortus (Sanofi Pasteur) nirsevimab monoclonal antibody- given to a baby after birth if the mother did not receive the RSV vaccine at least 14 days prior to delivery or if status is unknown. Also recommended for a small group of young children ages 8-19 months who are at an increased risk for severe RSV before or entering their second RSV season⁴. 

References:

1. Centers for Disease Control and Prevention. Clinical Overview of RSV Accessed October 14, 2024. Updated August 30, 2024, https://www.cdc.gov/rsv/hcp/clinical-overview/
2. MLN908764 – Medicare Part D Vaccines
3. Centers for Disease Control and Prevention. ACIP Recommendations: RSV Vaccine. Accessed October 14, 2024. Updated July 26, 2024 https://www.cdc.gov/acip-recs/hcp/vaccine-specific/rsv.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/rsv.html
4. Centers for Disease Control and Prevention. RSV Guidance for Infants and Young Children. Accessed October 14, 2024. Updated August 30, 2024, https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/infants-young-children.html