UPDATE 2/9/24: supply has increased somewhat and we now have both 50 mg and 100 mg nirsevimab in place, as well as Abrysvo for people who are pregnant!

UPDATE 11/16/23 (allocation day): Sanofi allocated some additional doses of 50 mg today as part of their “carefully managed supply” — we were not allocated any doses, therefore we can’t order any doses. The state was allocated some additional doses by the CDC — tribal clinics will be prioritized for doses of 100 mg, and birthing hospitals and tribal clinics will be prioritized for doses of 50 mg. The number of doses is laughably small, so we don’t have very high hopes for being allocated any additional doses of either product by the state.

UPDATE 11/11/23: the outlook is not good for nirsevimab supply. The smaller 50 mg dose is no longer available to be ordered, and Sanofi has indicated they do not intend to restock this season. The best we can do is offer Abrysvo for people who are pregnant. We have that in stock now, please text us for info.

UPDATE 10/31/23: almost immediately after nirsevimab was released, they ran out of the 100 mg dose (for babies over 11 pounds). We continue to try to obtain it, and are maintaining a waitlist. We are still able to get some 50 mg doses (for babies under 11 pounds), but we’re buying those privately and are asking for pre-payment. Please text us for info.

In the meantime, it makes sense to try to get vaccinated during pregnancy with Abrysvo between 32-36 weeks. You may be able to get this at a pharmacy (if they refuse because you are not over 60, show them this ACIP recommendation). We are also starting to stock it in our clinic too — text us to arrange, since we’re purchasing very small volumes to start. You don’t need to be our patient (though we are happy to discuss pediatric care if you are looking for a pediatric provider!) and will bill most insurance and Medicaid plans.

For the first time in history, we will have options for passive protection from RSV. A vaccine during pregnancy, or an antibody given directly to baby after birth. Generally only one or the other would be given, not both.

RSV info:

On 10/19/23 Dr Kass did a group visit on Zoom to present information and answer questions about nirsevimab — see the slides here

For infants under 8 months:

Nirsevimab (Beyfortus) is a monoclonal antibody that provides protection to the baby for as long as the antibody is circulating, which is thought to be at least 5 months. Nirsevimab will probably ship in early October.

Codes to ask about:

if weight is less than 5 kg (11 lbs 0.37 oz), 50 mg product, CPT 90380 with Diagnosis (ICD10) Z29.11

if weight is 5 kg (11 lbs 0.37 oz) or more, 100 mg product, CPT 90381 with Diagnosis (ICD10) Z29.11

96380 Administration of respiratory syncytial virus, monoclonal antibody, with counseling by physician or other qualified health care professional

96381 Administration of respiratory syncytial virus, monoclonal antibody

This product has an estimated price of $500.

Typically vaccines in Washington State are provided through the Childhood Vaccine Program, administered by the Washington Vaccine Association. The CVP purchases vaccines and distributes them to providers, so there is no cost to the provider, and then providers bill insurance on behalf of the CVP. The WVA voted to include nirsevimab in the CVP, which is phenomenal, but it will take some time to get that up and running. We have placed an order through the CVP but do not have any timeline on shipping.

As RSV cases begin to rise before nirsevimab is available through CVP, or for the infant who will turn 8 months before nirsevimab is available through CVP, we are purchasing the antibody privately.

Given the price, we are asking for payment up front of $550 to cover nirsevimab and administration fees. We will provide a superbill (invoice) and receipt for you to submit to your insurance company for reimbursement.

You can also ask the hospital where you plan to give birth if they are planning to obtain and administer nirsevimab.

For babies 8-19 months:

Some children should receive a dose of nirsevimab in their second RSV season:

Children with chronic lung disease of prematurity who required medical support (chronic corticosteroid therapy, diuretic therapy or supplemental oxygen) any time during the 6-month period before the start of the second RSV season. 
Children who are severely immunocompromised.  
Children with cystic fibrosis who have manifestations of severe lung disease (previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persist when stable) or have weight-for-length that is <10th percentile. 
American Indian and Alaska Native children (note that this is a new group for whom second-season prophylaxis is recommended in contrast to the current palivizumab recommendations).

These children should receive 2 x 100 mg, so the codes would be 2 units of CPT 90381 with Diagnosis (ICD10) Z29.11.

For pregnant people:

Abrysvo is a vaccine given to pregnant people between 32-36 weeks gestation, with the goal of producing antibodies to be exported to baby, so they’re born pre-stocked with antibodies against RSV. Abrysvo is currently available in pharmacies. Caution: there is a different RSV vaccine for older adults, Arexvy, that is NOT approved for pregnancy. If you get vaccinated at a pharmacy, confirm with your own eyes that you’re receiving Abrysvo, not Arexvy.

Codes to ask about:

CPT 90678 Abrysvo RSV vaccine with Diagnosis (ICD10) Z23

This product has an estimated price of $350 (updated after it actually went on sale).

Products for prevention of RSV (updated 2/9/24 with good news!)

RSV info:

For infants under 8 months:

For babies 8-19 months:

For pregnant people: