Illinois HFS Medicaid · October 6, 2026 · Primary source
Upcoming Respiratory Syncytial Viral (RSV) Season
Summary
Illinois HFS has issued its annual provider notice on RSV immunization coverage policies for the upcoming RSV season under both Medicaid FFS and MCOs. The notice covers monoclonal antibodies Beyfortus (nirsevimab) and Enflonsia (clesrovimab) for infants under 8 months, Beyfortus for high-risk children in their second RSV season, the maternal RSV vaccine Abrysvo for pregnant individuals at 32 to 36 weeks gestation, and adult RSV vaccines for patients 75 and older or at elevated risk. Prior authorization is not required for any of the recommended immunizations.
What this may mean
Illinois Medicaid providers administering RSV vaccines and monoclonal antibodies to covered populations may bill FFS or MCOs without prior authorization for the recommended products and populations described in the notice.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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