Welcome Logout

Respiratory Syncytial Virus (RSV)

Age-appropriate immunizations for RSV are covered in accordance with Centers for Disease Control and Prevention (CDC) age and frequency recommendations.

For most of the United States, RSV season is September to May. In communities where there is elevated RSV viral isolation reported by either the CDC or local public health authorities, RSV season may begin earlier. 

See also injection/infusion medication.

Beyfortus™

Beyfortus (nirsevimab) is an RSV vaccine that assists in the prevention of RSV.

Effective Aug. 3, 2023, the RSV antibody Beyfortus may be covered under TRICARE’s clinical preventive services benefit. Per CDC guidelines, the RSV antibody may be given to:

  • Infants younger than 8 months of age born during RSV season or entering their first RSV season
  • Children aged 8 months through 19 months who are at increased risk for severe RSV disease and entering their second RSV season

Synagis®

Synagis (palivizumab) is a limited benefit. Synagis is an RSV vaccine that assists in the prevention of RSV. Coverage is limited to one dose per month up to a maximum of five consecutive doses for newborns or infants with one of the following:

  • Prematurity
  • Chronic lung disease
  • Congenital heart disease
  • Severe immunodeficiency
  • Congenital abnormalities of the airway or neuromuscular disease (for example, cerebral palsy, muscular dystrophy, neurological diseases of the brain and spinal cord like Tay-Sachs disease or spinal muscular atrophy)

While the RSV season begin/end dates may shift, the duration of Synagis injections remains five consecutive months for all geographic areas in the United States.

To expedite the review process for limited benefits, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request. 

Abrysvo® 

The RSV vaccine Abrysvo® (respiratory syncytial virus vaccine) is a limited benefit. Abrysvo is a vaccine indicated for active immunization of pregnant individuals who are 32 to 36 weeks pregnant during the months of September through January and individuals 60 years of age and older. 

Arexvy®

The RSV vaccine Arexvy (respiratory syncytial virus vaccine, adjuvanted) is a vaccine indicated for active immunization for individuals 60 years of age and older.