RSV season is ramping up, and doctors are hoping a new shot to prevent the virus in young children will ease the caseload this year. However, some pediatricians are facing challenges getting supply.
The CDC and FDA have approved the Beyfortus antibody shot, from drugmakers AstraZeneca and Sanofi, to prevent respiratory syncytial virus in babies from birth to 8 months old, or in children up to 24 months old with severe risk factors.
Children younger than 1 year old are primarily admitted to hospitals due to RSV.
According to Dr. Lauren Fitzpatrick, the medical director of the pediatric unit at Luminis Health Anne Arundel Medical Center, pediatricians expressed optimism about the drug’s potential in decreasing the number of cases following a remarkable year in 2022.
“We thought that this was groundbreaking, that this could be our game-changer, that we could potentially really reduce the risk of patients being admitted for RSV,” she told CBS News. “I think there was our hopes, and then there was our reality,”
Due to the absence of an established infrastructure, both the vaccine and monoclonal antibodies cannot be readily distributed, despite the numerous requests from families. Consequently, we are unable to fulfill their demands.
Currently, the cost is a major complication, with each dose priced at approximately $500. Although it is anticipated that most insurance plans will cover the shot, healthcare providers are required to order supplies without knowing the exact reimbursement amount they will receive.
Fitzpatrick expressed frustration as a pediatrician, stating, “We are filled with anger, as it seems that we may overlook a valuable opportunity.”
Having experienced it herself as a mother, Fitzpatrick deeply understands the significance of this vaccination. When her youngest child was 9 months old, they faced difficulties due to RSV.
She expressed, “The period was extremely difficult. I don’t want this situation to be reduced to mere financial figures. It’s about my child’s life, after all. However, for many insurance companies, it all comes down to dollars and cents.”
In the summer, the American Academy of Pediatrics wrote a letter to the CDC and the Centers for Medicare and Medicaid Services, urging federal leaders to ensure the widespread and fair distribution of the shot.
In addition to administering the drug, the CDC has recently announced that pediatricians will now be compensated for providing counseling to families about the medication.
Fitzpatrick expresses her desire for insurance companies to offer clearer information regarding their coverage for the costly shot.
She explained that these small practices lack the necessary capital for investment. She suggested that having a plan in place, where insurance companies can collaborate with the practices to either speed up reimbursement or provide upfront funding, would be beneficial.
A Sanofi spokesperson acknowledged the potential delay in receiving reimbursement from payers and stated that the company is providing “extended payment terms for Beyfortus to providers who make direct purchases from Sanofi,” as mentioned in their statement to CBS News.
The statement continued, elaborating that providers have the flexibility to order and receive Beyfortus to administer during the respiratory syncytial virus (RSV) season without having to reimburse Sanofi until the end of the RSV season.
Molly Fleenor, who is anticipating the arrival of her second daughter in December, the height of RSV season, expresses her desire for a timely resolution to the confusion.
Fleenor emphasized that the process should not rely on guesswork. Instead, it should be straightforward and easily understandable, ensuring accessibility for as many individuals as possible, if not everyone.
Fleenor will also be eligible for the new RSV vaccine for pregnant women in their third trimester, to help protect her baby.
Doctors are suggesting that Fleenor either consider getting the shot for her mom or immunize the newborn. Despite being unsure, Fleenor acknowledges the importance of protection and is contemplating her decision.
“It’s really frightening,” she expressed, “how rapidly RSV can escalate, leaving children extremely ill.”
It is recommended by the American Academy of Pediatrics that all infants whose mothers did not receive the maternal vaccine be given the new preventive antibody, particularly those who are at a higher risk for RSV.
- In:
- RSV
- Respiratory Syncytial Virus
