Covered and Noncovered Services : Covered Services and Requirements

Beyfortus Covered Through the Vaccines for Children Program

Beyfortus (nirsevimab), a monoclonal antibody, is used for the prevention of lower respiratory tract disease caused by RSV in infants or children.

The CDC's ACIP recommends the routine use of Beyfortus for the prevention of RSV for newborns and infants younger than 8 months of age born during or entering their first RSV season. The ACIP also recommends the routine use of Beyfortus for children aged 8 to 19 months who are at increased risk of severe RSV, which includes Alaska Native and American Indian children, as defined by the Indian Health Care Improvement Act, who are entering their second RSV season.

Beyfortus Supplied Through the Vaccines for Children Program

The federal VFC Program was created to provide vaccines to eligible children through enrolled public and private providers. The VFC Program is part of a national approach to improving immunization services and levels.

Although not a vaccine, the ACIP voted to include Beyfortus in the VFC Program.

ForwardHealth covers Beyfortus consistent with current policies for immunization services. Therefore, providers are required to obtain Beyfortus for children from the VFC supply. ForwardHealth reimburses only an administration code for Beyfortus supplied through the VFC Program.

Providers may refer to the Wisconsin Immunization Program for contact information about enrolling in the VFC Program.