RSV Drug Shortages and Insurance Confusion Leave Parents Struggling to Protect Infants
The 2023-2024 virus season is the first since the FDA approval of a new preventative drug, Nirsevimab (Beyfortus), for respiratory syncytial virus (RSV) in infants and toddlers. Although this breakthrough has brought relief to parents, the high demand, limited supply, and insurance confusion have made it difficult for many parents to obtain the drug.
Here’s what you need to know about the new RSV drug and the challenges parents are facing, as told by two moms:
An Overview of the New RSV Drug
Nirsevimab, also known as Beyfortus, was approved by the FDA in July and is recommended by the CDC for infants born during or entering the first RSV season (under 8 months old) and for children between 8 and 19 months, who are at high risk for severe RSV disease.
Unlike a vaccine, Nirsevimab is a preventative drug administered via shot, which delivers long-acting antibodies to provide passive immunity against RSV. This is especially important for children under 6 months old or those with compromised immune systems. RSV can cause mild symptoms, but it can also lead to bronchiolitis and is a common cause of hospitalization for infants.
Why Parents Are Struggling to Access the Drug
Given the risks associated with RSV and the surge in cases last year, many parents are seeking the Nirsevimab drug but are facing shortages or unavailability at their pediatrician’s office. Sanofi, one of the drug manufacturers, has reported higher-than-expected demand, resulting in insufficient doses for all eligible infants.
In response, the CDC recommended prioritizing the highest-risk babies (under 6 months old or with underlying conditions) with the highest dose of Nirsevimab. The CDC also advises against giving Nirsevimab to children aged 8 to 19 months who are eligible for the shorter-acting alternative, palivizumab.
However, even parents of high-priority babies have encountered difficulties booking appointments or finding the shot available. Some parents have received mixed messages about insurance coverage and eligibility, with doctors allowing older toddlers without underlying health conditions to receive the drug.
Two Moms Share Their Experiences
Arlie’s Story: ‘We’re taking tons of precautions until he can get the shot.’
Arlie, based in North Carolina, has been eager to get the Nirsevimab drug for her 6-month-old baby, Everett. Despite being near the age cutoff, she hopes to secure the shot before it’s too late. However, insurance issues and supply problems have hindered her efforts.
Until then, Arlie’s family is taking numerous precautions, including masking indoors, dining outdoors, and screening visitors for illness. Her parents have even received the senior version of the RSV shot for added protection.
Leslie’s Story: ‘We were charged $520. It is unclear if that will be reimbursed.’
Leslie, from Texas, has three sons, and she wanted to prevent her youngest from getting sick due to his older brothers’ exposure in school. She proactively inquired about the RSV drug, but the doctor’s office warned about potential insurance issues. Eventually, Leslie paid $520 out of pocket, unsure if insurance will reimburse the cost.
While Leslie believes it was the right decision for her family, she is concerned that logistical challenges and costs may limit access to the drug for other families.
If you’re a parent seeking the Nirsevimab drug, it’s important to stay persistent, communicate with your healthcare provider, and explore alternative options if necessary. Protecting infants from severe RSV disease remains a top priority.
