Insurers Push Back on Covering RSV Shots for Newborns in Hospitals

October 16, 2026 - 21:46

A growing number of hospitals are reporting that infants are being discharged without protection against respiratory syncytial virus, or RSV, because insurance companies are refusing to cover the immunization while the baby is still in the hospital.

The shot in question is nirsevimab, sold under the brand name Beyfortus. It is a monoclonal antibody designed to shield infants from RSV, a common virus that can cause severe breathing problems in very young children. Federal health officials recommend the immunization for newborns and for babies entering their first RSV season.

The problem is where the shot is given. When a hospital administers the dose before discharge, some insurers classify it as part of the inpatient stay rather than as a pharmacy benefit. That distinction matters because it can determine whether the cost is covered at all, or whether the hospital absorbs it.

Hospitals say the result is a confusing patchwork of rules that varies by insurer and by state. Some facilities have stopped offering the shot to newborns altogether, telling parents to seek it from a pediatrician after leaving the hospital. That delay can leave infants unprotected during the weeks when they are most vulnerable.

Insurers argue that the matter involves billing codes and benefit design, not a refusal to cover the treatment. They say the shot can be covered when administered in an outpatient setting.

Public health experts warn that the dispute could undermine efforts to reduce RSV hospitalizations, which surged in recent seasons and overwhelmed pediatric wards in several parts of the country.