A respiratory syncytial virus (RSV) vaccine.

A respiratory syncytial virus (RSV) vaccine. Credit: Getty Images/iStockphoto/Hailshadow

Federal health officials have touted the new RSV vaccine as a key tool that will help vulnerable populations fight off the potentially serious respiratory disease this winter. But people on Long Island and across the nation are finding out it could come with a hefty price tag around $300.

Even though the Centers for Disease Control and Prevention recommends the vaccine for people 60 and older, infants, young children and some people who are pregnant, insurance companies have a year before they must start offering it for free.

Some health plans are covering the vaccine now, while others are having patients foot the bill.

Seniors with Medicare Part D are covered, but six million of those covered by Medicare without that prescription drug plan may be stuck with a bill, for example. About 57 million older adults have Medicare.

Those with private insurance need to check with their providers.

“If people have to pay out of pocket, it’s going to be a huge deterrent,” said Dr. Bradley Sherman, chair of medicine at Glen Cove Hospital. “That is a problem for those people who should get it but may not because of the cost.”

The vaccine, first approved in May, comes after an especially tough RSV season. The CDC estimates 80,000 children younger than 5 as well as 160,000 older adults were hospitalized due to respiratory syncytial virus last season. And the agency said 300 children and 10,000 older adults died from RSV during that time.

Still, some doctors who treat older adults are taking a wait-and-see approach with the new vaccine and only recommending it for people at the highest risk of developing severe illness from RSV.

Several local pharmacies are offering the vaccine but said cost is dependent on each person’s insurance plan. This may be a surprise for some people after years of free COVID-19 vaccines.

There are several different vaccines and treatments for RSV approved by the FDA and recommended by the CDC.

Arexvy and Abrysvo, which are brand names for the vaccines, were approved for those 60 and older.

The CDC recommended that adults 60 and older may receive a single dose of RSV vaccine after consultation with a health care professional.

Abrysvo was also approved for people who are pregnant at 32 to 36 weeks gestation. The CDC recommended one administered immediately before or during RSV season.

Beyfortus, a monoclonal antibody treatment administered in a shot, was approved for children up to 24 months of age. The CDC recommended one dose for all infants younger than 8 months born during or entering their first RSV season and one dose for infants and children 8 to 19 months of age who are at increased risk of severe RSV disease and entering their second RSV season.

Dr. Irving Gomolin, chief of geriatric medicine at NYU Langone Hospital — Long Island, said many of his patients are asking about the vaccine.

“Some elderly people are very interested,” he said. “From my experience, patients are asking about it and patients are getting vaccinated.”

The vaccines for older adults and women who are pregnant are available at several large chain pharmacies, such as CVS, Rite Aid and Walgreens. Some doctor’s offices may also be administering them.

The Beyfortus treatment for very young children is expected to be available later this month, which most will be able to receive at their pediatrician's office.

Whether you will be charged for the RSV vaccine depends on your health insurance.

Even though vaccines recommended by the CDC are covered at no-cost under the Affordable Care Act there are lots of caveats, including that private insurers have up to a year to cover it, said Jennifer Kates, a senior vice president at the San Francisco-based health policy nonprofit KFF.

“Some of them may already be deciding to cover it,” Kates said. “They don’t have to wait a year. There’s a lot of public attention on this.”

While the CDC recommendations for people who are pregnant, infants and young children are fairly straightforward, the one for older adults leaves room for discussion, referred to as “shared clinical decision making.”
“Adults 60 years and older should talk with their health care provider about whether RSV vaccination is right for them,” according to the CDC website.
Sherman said almost all of his older patients want to have a discussion about the RSV vaccine — even those who aren’t sure they want it. The decision whether to get the RSV vaccination should be considered on a case-by-case basis.

“My opinion is that if you are over 60 and you have concurrent medical problems that, if you were to get RSV you would be at risk of being hospitalized or dying, you should get vaccinated,” he said.

He said those medical issues include heart or lung disease and people with compromised immune systems.

Federal health officials have touted the new RSV vaccine as a key tool that will help vulnerable populations fight off the potentially serious respiratory disease this winter. But people on Long Island and across the nation are finding out it could come with a hefty price tag around $300.

Even though the Centers for Disease Control and Prevention recommends the vaccine for people 60 and older, infants, young children and some people who are pregnant, insurance companies have a year before they must start offering it for free.

Some health plans are covering the vaccine now, while others are having patients foot the bill.

Seniors with Medicare Part D are covered, but six million of those covered by Medicare without that prescription drug plan may be stuck with a bill, for example. About 57 million older adults have Medicare.

Those with private insurance need to check with their providers.

“If people have to pay out of pocket, it’s going to be a huge deterrent,” said Dr. Bradley Sherman, chair of medicine at Glen Cove Hospital. “That is a problem for those people who should get it but may not because of the cost.”

The vaccine, first approved in May, comes after an especially tough RSV season. The CDC estimates 80,000 children younger than 5 as well as 160,000 older adults were hospitalized due to respiratory syncytial virus last season. And the agency said 300 children and 10,000 older adults died from RSV during that time.

Still, some doctors who treat older adults are taking a wait-and-see approach with the new vaccine and only recommending it for people at the highest risk of developing severe illness from RSV.

Several local pharmacies are offering the vaccine but said cost is dependent on each person’s insurance plan. This may be a surprise for some people after years of free COVID-19 vaccines.

Who is eligible for the RSV vaccine?

There are several different vaccines and treatments for RSV approved by the FDA and recommended by the CDC.

Arexvy and Abrysvo, which are brand names for the vaccines, were approved for those 60 and older.

The CDC recommended that adults 60 and older may receive a single dose of RSV vaccine after consultation with a health care professional.

Abrysvo was also approved for people who are pregnant at 32 to 36 weeks gestation. The CDC recommended one administered immediately before or during RSV season.

What about a new monoclonal antibody RSV treatment?

Beyfortus, a monoclonal antibody treatment administered in a shot, was approved for children up to 24 months of age. The CDC recommended one dose for all infants younger than 8 months born during or entering their first RSV season and one dose for infants and children 8 to 19 months of age who are at increased risk of severe RSV disease and entering their second RSV season.

Where can I get the vaccine?

Dr. Irving Gomolin, chief of geriatric medicine at NYU Langone Hospital — Long Island, said many of his patients are asking about the vaccine.

“Some elderly people are very interested,” he said. “From my experience, patients are asking about it and patients are getting vaccinated.”

The vaccines for older adults and women who are pregnant are available at several large chain pharmacies, such as CVS, Rite Aid and Walgreens. Some doctor’s offices may also be administering them.

The Beyfortus treatment for very young children is expected to be available later this month, which most will be able to receive at their pediatrician's office.

Who has to pay for the RSV vaccine?

Whether you will be charged for the RSV vaccine depends on your health insurance.

Even though vaccines recommended by the CDC are covered at no-cost under the Affordable Care Act there are lots of caveats, including that private insurers have up to a year to cover it, said Jennifer Kates, a senior vice president at the San Francisco-based health policy nonprofit KFF.

“Some of them may already be deciding to cover it,” Kates said. “They don’t have to wait a year. There’s a lot of public attention on this.”

Should I get the RSV vaccine, even if I'm eligible?

While the CDC recommendations for people who are pregnant, infants and young children are fairly straightforward, the one for older adults leaves room for discussion, referred to as “shared clinical decision making.”
“Adults 60 years and older should talk with their health care provider about whether RSV vaccination is right for them,” according to the CDC website.
Sherman said almost all of his older patients want to have a discussion about the RSV vaccine — even those who aren’t sure they want it. The decision whether to get the RSV vaccination should be considered on a case-by-case basis.

“My opinion is that if you are over 60 and you have concurrent medical problems that, if you were to get RSV you would be at risk of being hospitalized or dying, you should get vaccinated,” he said.

He said those medical issues include heart or lung disease and people with compromised immune systems.

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Jets radio changing stations … Landfill violations … Strawberry on Mets season  Credit: Newsday

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