The 2023-2024 Virus Season: The Challenges of Getting the New RSV Drug

The 2023-2024 virus season brings a major breakthrough in the fight against respiratory syncytial virus (RSV), a common childhood illness. The Food and Drug Administration (FDA) has approved a new preventative drug called Nirsevimab, also known as Beyfortus, which aims to protect infants and toddlers from RSV. However, despite its approval, parents are facing difficulties accessing the drug due to high demand, supply issues, and confusion over insurance. Let’s take a closer look at what’s happening and hear the stories of two moms who have experienced these challenges firsthand.

What You Need to Know About the New RSV Drug

Nirsevimab, or Beyfortus, received FDA approval in July and is recommended by the Centers for Disease Control and Prevention (CDC) for babies born during or entering the first RSV season (under 8 months of age) and children between 8 and 19 months old. This age group is especially vulnerable to severe RSV disease. Nirsevimab is not a vaccine but a preventative drug that is administered via a shot. It works by providing long-acting antibodies that help prevent the spread of RSV, which is crucial, particularly for young children and those who have compromised immune systems. RSV can cause mild symptoms like coughing and fever, but it can also lead to more serious conditions such as bronchiolitis and hospitalization for infants.

Challenges in Accessing the Drug

Despite the risks associated with RSV and the increased demand for the drug, it is currently facing supply shortages. Sanofi, one of the drug manufacturers, has reported higher demand than anticipated, leading to insufficient doses to protect all eligible infants for the 2023-2024 RSV season. To address this, the CDC has recommended prioritizing the highest dose of Nirsevimab (100mg) for high-risk babies, specifically those under 6 months old and infants with underlying conditions. Infants aged 8 to 19 months who are eligible for another treatment called palivizumab should not receive Nirsevimab to preserve supply. However, parents of high-risk babies have still struggled to book appointments or find the shot available, facing mixed messages about insurance coverage and eligibility.

Two Moms Share Their Experiences

“We’re Taking Tons of Precautions Until He Can Get the Shot”

Arlie, from North Carolina, wants the RSV drug for her 6-month-old baby, Everett. Given the rising cases of RSV and the potential danger it poses to infants, Arlie is concerned. However, Everett is close to the age cutoff outlined by the CDC recommendations. Arlie’s pediatrician has indicated that insurance issues might delay the availability of the drug. Arlie remains hopeful that these problems will be resolved before Everett’s next visit in early November when he is scheduled to receive his first COVID shot. If the drug is still unavailable, Arlie plans to explore other offices where Everett might be able to receive the shot within the recommended eligibility window. In the meantime, Arlie’s family is taking numerous precautions to ensure Everett’s safety, such as wearing masks indoors, dining outdoors, and screening visitors for illnesses.

“We Were Charged $520. It Is Unclear if That Will Eventually Be Reimbursed by Insurance”

Leslie, a mom from Austin, Texas, has three boys ranging from 5 months to 5 years old. She wants to protect her youngest son from RSV, especially since her older sons attend school. Leslie proactively inquired about the RSV drug in early September and got on a waitlist. She followed up with the doctor’s office as the season progressed, but they warned her about potential insurance issues. Leslie was informed that they would charge the full out-of-pocket rate as insurance coverage was unclear for the new vaccine. In late October, she had a same-day appointment and was charged $520 for the drug. The reimbursement from insurance remains uncertain. Leslie is disappointed that logistical challenges and the up-front cost of the drug may prevent other families from accessing it. She believes RSV is a severe virus and hopes that the barriers to widespread distribution can be resolved.

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