Respiratory syncytial virus (RSV) activity in the United States remains variable by region but is increasing in some parts of Missouri, including St. Louis and Kansas City metropolitan areas. The shift in seasonality for RSV was first noted in 2021. The American Academy of Pediatrics (AAP) supports the use of palivizumab in eligible infants in any region experiencing rates of RSV activity at any time in 2022, similar to a typical (pre-2020) fall-winter season.
Based on the increases in RSV activity, the MO HealthNet Division (MHD) will begin to review requests for RSV prophylaxis effective September 1, 2022. Participants who meet the clinical edit requirements, including age restrictions, may receive approval for up to five doses for the 2022 – 2023 RSV season, depending on the requested date for the initial prior authorization. MHD recommends pharmacies coordinate with providers to ensure a scheduled appointment exists with their patient to administer palivizumab before sending doses to reduce abandoned medication. MHD will evaluate claims to ensure there is no excessive waste.
Given the regional variation in RSV activity, please consider your local RSV rates when determining when to initiate palivizumab. The duration of the current RSV season cannot be predicted; consider ordering single doses of palivizumab each month (rather than five monthly doses at the start of the season). Close monitoring of local RSV activity will determine a stop date for RSV prophylaxis; MHD may end the approved prior authorization early if the RSV season is determined to conclude before all doses are administered. If the 2022 – 2023 RSV season ends earlier than typical (pre-2020) RSV seasons, MHD will send out a provider blast to notify providers. Providers with questions may call MO HealthNet at 800-392-8030.