Two new immunizations have emerged to shield babies from respiratory syncytial virus (RSV) — provided they can go through significant hurdles.
Healthcare providers are rushing to offer Pfizer’s Abrysvo vaccine to pregnant patients and Sanofi’s monoclonal antibody, Beyfortus, to infants.
These treatments safeguard newborns from RSV complications and have recently been approved, just as the respiratory virus season begins.
However, the tight schedule allows little time to resolve logistical challenges such as insurance coverage, and the high cost of these immunizations makes some providers cautious about stocking up without assurance of reimbursement for administration.
These obstacles risk delaying infants’ access to protection this winter and may impede the rollout of both medications.
“We want to start protecting babies now,” emphasized Dr. Michael Chamberlin from Pediatric Associates of Mt. Carmel in Cincinnati, Ohio. He expressed frustration over the lack of clarity from insurers regarding coverage for Beyfortus and reimbursement rates.
RSV, which typically presents as a cold in adults, poses significant risks to newborns, seniors, and adults with chronic conditions, often leading to hospitalization among infants.
Until now, the sole preventive treatment has been Synagis, another monoclonal antibody administered monthly during the RSV season, costing approximately $1,000 per dose and recommended only for high-risk infants.
The new options, Abrysvo and Beyfortus, function differently but share the goal of expanding protection against RSV in newborns.
Abrysvo is a vaccine administered during pregnancy to stimulate an immune response passed to the fetus.
Beyfortus, on the other hand, is a monoclonal antibody given directly to infants for immediate protection. Both reduce the risk of severe illness or hospitalization by over 50%.
“Whether it’s a neighbor, friend, or older sibling who was hospitalized, everyone knows what [RSV] is,” said Erin Bakke, whose 4-month-old son received the Beyfortus shot this week. “To prevent illness in the first place is really exciting.”
Dr. Laura Riley, chair of obstetrics and gynecology at Weill Cornell Medicine and New York-Presbyterian, initially hesitated to offer Abrysvo due to its $295 price tag, higher than other maternal vaccines like those for whooping cough at around $50.
However, patient difficulties in accessing the vaccine at pharmacies led her to provide it directly in her office, recognizing the importance of convenience for vaccination uptake.
Pfizer acknowledged access challenges likely stem from the rapid transition from Abrysvo’s recommendation for use during pregnancy to widespread administration.
Although the vaccine received formal endorsement earlier this month, some pharmacies and insurers await this final step before administering or covering new vaccines. Abrysvo was approved for individuals aged 60 and older in May.
While Sanofi stated that over 90% of infants are already covered by health plans for Beyfortus, Pfizer noted early positive momentum. Nonetheless, insurers anticipate delays as they adjust policies.
“Coverage during the one-year implementation period will vary … as system, technical, and coding issues may arise,” explained Kelly Parsons of the Blue Cross Blue Shield Association.
At Pediatricians of Dallas, where Graham Bakke received Beyfortus, Dr. James Watkins disclosed purchasing about 200 doses initially to gauge insurer acceptance before scaling up for an estimated 1,000 infants this season.
Despite insurers reimbursing at rates below the shot’s cost, Watkins affirmed the importance of immunization, stating, “If we lose a little money, we’ll see you for other things, and that’s just part of the game.”
