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Enflonsia (New RSV Monoclonal Antibody): Update on Payer Coverage
At this time, no official pricing or reimbursement rates have been released by payers for Enflonsia, the newly approved RSV monoclonal antibody.
Our Provider Relations team is actively engaging with both KHF and TCCN payer partners, providing ongoing follow-up and reminders. The timeline for Enflonsia’s rollout—ACIP and FDA approvals, and anticipated MMWR publication—closely mirrors the release of Beyfortus last year. Many payers began covering Beyfortus in November, with most completing implementation by December.
The delay stems primarily from the introduction of a new CPT code. Before coverage can begin, each payer must finalize their internal policy on the code and complete system configuration. Most payers traditionally wait until the MMWR publication before initiating action, though we continue to advocate for earlier adoption.
We’ve also raised these concerns with Merck directly, and their teams are working to accelerate payer engagement from their side as well.
Once we begin receiving reimbursement data, we will conduct a comparative financial analysis between Enflonsia and Beyfortus and share those findings with our practices.
We will share updates as soon as we have more information. Contact Barbara Douglas with questions on this topic.
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