Employers weigh start of RSV immunization coverage 

We are just starting to see the expected winter upswing in positive detections of Respiratory Syncytial Virus (RSV) across the US. Those at increased risk of severe RSV infections can benefit from the available vaccinations and therapies. Ideally, cost would not be a factor in the decision to seek vaccination or treatment.  

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices now recommends a single dose RSV vaccine for those 60 or older in consultation with a healthcare provider. The CDC also recommends maternal RSV vaccination at 32-36 weeks’ gestation (administered immediately before or during RSV season) to protect babies through the first six months of life. And a new immunization, Nirsevimab, is available for infants under 8 months born during or entering their first RSV season and children at increased risk for RSV who are aged 8-19 months entering their second RSV season.  

Calendar-year non-grandfathered group health plans will be required to cover these immunization products without participant cost-sharing starting Jan. 1, 2025. For non-calendar-year plans, the required date for no-cost coverage could be the plan year beginning in 2024 or 2025, depending on when the plan year starts relative to the date the recommendation was adopted by the CDC. Of course, plans can begin zero-cost sharing coverage prior to these dates. 

Should employers begin coverage now?

At this stage in our experience with the vaccine and immunization, the recommendation for RSV vaccination and immunization for high-risk individuals makes clinical and cost-benefit sense. We think it’s particularly beneficial for pregnant persons to get vaccinated to protect their babies. Some employers have expressed concern about providing coverage now given the limited supply of the RSV monoclonal antibody Nirsevimab. Vaccine and therapeutic shortages can produce an external constraint and lead to difficulties for consumers to get the treatment they need. Ideally, the utilization is based on risk-based priority and shared clinical decision-making to ensure the available treatments truly are used by those who benefit the most. The CDC has issued guidance for clinicians to address this concern. 

The RSV vaccinations and therapeutic options are recommended to protect those individuals at higher risk of severe illness if infected. The largest benefit with vaccination occurs when those who can benefit the most participate in the vaccination program. Hence, broad coverage recommendations and no-cost programs align and remove barriers to broad population engagement, leading to the optimal impact.   

RSV transmission can be slowed with the same type of personal hygiene and self-care used with other common respiratory infections like the common cold, influenza and COVID.  Employers can help by providing convenient access to disinfectant wipes and, surgical or N95 face masks. Good quality air filtration will decrease transmission rates for these respiratory viruses also. In addition, employers can communicate the importance of staying at home if employees have any signs or symptoms of respiratory infection.