Infants born between April 2025 thru March 2026 may qualify for the antibody after 10/1/2025.
Those less than 22 months with a history of prematurity, or other severe chronic conditions may also qualify.
- Please contact your insurance company using the member services number listed on your ID card. You must obtain a reference number for your call.
- Beyfortus is not considered a vaccine; it is a preventative antibody and is therefore processed differently than other vaccines. While coverage has improved compared to last year, some insurance plans still require prior authorization.
- When speaking with the representative, ask if Beyfortus is a covered benefit under your plan. If they request a CPT code, provide:
- 90380 if your infant weighs less than 5 kg (approximately 11.5 lbs)
- 90381 if your infant weighs more than 5 kg
- If Beyfortus is covered, also ask if you have met your deductible and what your expected copay or coinsurance will be. Some families may have no out-of-pocket cost, while others may be responsible for the full amount of $625.
- After your call, please send us a portal message with your reference number and the expected deductible/copay amount. This amount will be due at the time of your appointment.
- Once we receive your message, we will verify eligibility. This process may take up to 48 business hours, after which your infant’s appointment will be scheduled.