KANSAS CITY, Mo. — There is a new shot to protect newborns against respiratory syncytial virus (RSV), but parents may not be able to get it or afford it.
There is a lack of supply and it costs too much, an average of $500 without insurance.
Beyfortus was recently approved by the US Food and Drug Administration in the summer. It cut down the risk for being hospitalized due to RSV by 80 percent in clinical trials.
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But the tight deadline leaves little room to resolve logistical hurdles like insurance coverage.
“I think the real question brought up, this year at least, had been how different insurers were going to cover it, and if it’s was going to be classified as a vaccine under the Vaccine for Children’s Program or how it was gonna be," said Dr. Maya Moody, the president of American Academy of Pediatrics Missouri Chapter. "That equity access to all of our kids in Missouri — it’s really been a struggle this year."
Under the Affordable Care Act, most health insurance plans have to cover the cost of immunizations like Beyfortus with no cost to the patients.
But because of a loophole in the law, insurance companies have a year to add new products to their coverage plans.
Back in August, the CDC acted quickly to add Beyfortus to its schedule of routine childhood immunizations. This will eventually trigger full insurance converge, but it has not taken effect yet.
“This really was a case study for inequity and access,” Moody said.
Because of this, some doctors have even decided not to offer it in the meantime. They cannot afford to order it without knowing whether they will be reimbursed.
Mariah Roady, who brought her seven-month-old daughter home on Tuesday after being hospitalized with RSV, says she asked their pediatrician for the shot before any of it happened.
“It’s frustrating, because I think all of this, our hospital stay and ambulance ride to downtown could have been avoided had we had access to that vaccine,” Roady said.
As a mother of two young children, she says the $500 price tag without insurance would have been worth it to skip the hospital.
“We do not want to go through what we went through again,” Roady said.
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