MedicaidCoverageMedium impact
[Indiana] Newborn RSV Prevention
CareSource·IN · Pediatrics, Family Medicine, OB-GYN·Provider Bulletin
Effective date
Jan 16, 2026
We identified it
Jun 13, 2026
Summary
CareSource Indiana Medicaid updated RSV prevention coverage effective January 16, 2026. Key changes include Synagis being discontinued as of December 31, 2025, and specific coverage requirements for RSV prevention medications including Abrysvo, Beyfortus, Enflonsia, with varying prior authorization requirements.
Action Required
Immediately: Billing team must update Indiana Medicaid billing procedures to reflect Synagis discontinuation as of December 31, 2025 (no longer covered). Verify coverage rules for RSV prevention medications: Abrysvo requires no medical PA but must use VFC provider if patient <19 years; Beyfortus requires no medical PA but not covered through pharmacy; Enflonsia covered per bulletin BT2025153 retroactive to July 1, 2025. Update encounter forms to reflect these coverage changes for newborn RSV prevention visits.