MedicaidPrior AuthMedium impact
[Georgia] Newborn RSV Prevention
CareSource·GA · OB-GYN, Pediatrics, Family Medicine·Provider Bulletin
Effective date
Jan 13, 2025
We identified it
Jun 13, 2026
Summary
CareSource Georgia Medicaid updated RSV prevention requirements for newborns. Abrysvo vaccine for pregnant women (32-36 weeks) requires no prior authorization, Beyfortus antibody for newborns requires no medical PA but is not covered at pharmacy, and Synagis antibody requires prior authorization for both medical and pharmacy administration.
Action Required
Immediately: Update billing workflows to reflect RSV prevention authorization requirements - Abrysvo (no PA needed for pregnant patients 32-36 weeks), Beyfortus (no medical PA but pharmacy not covered), Synagis (PA required for medical and pharmacy). Train staff on proper administration settings and ensure prior authorization is obtained for Synagis before administration to avoid claim denials.