RWJBarnabas Health
West Orange, NJ
The American Academy of Pediatrics recommends that during RSV season an RSV immunization be administered during the first week of life, ideally during the birth hospitalization.1 Our health system undertook an initiative to begin offering nirsevimab to all newborns born in our health system during their birth hospitalization. The cost for nirsevimab is about $500 per dose. Given that our health system sees about 12,000 births during RSV season (October-March), the projected cost of this initiative was $3 million if 50% of infants were immunized.
With our goal to administer RSV prophylaxis during birth hospitalization, a two-pronged approach to address cost was taken. First, payor contracts were renegotiated to incorporate the cost of nirsevimab in newborn diagnosis-related group (DRG) admission reimbursements with our largest insurers. Second, we enrolled our major birthing hospitals in the Vaccines for Children (VFC) program with the State of New Jersey. In New Jersey, only select Medicaid patients are eligible for VFC.2 Logic was created in the electronic health record (EHR) that evaluated insurance eligibility and linked the correct dispensable product: hospital-purchased commercial supply nirsevimab for patients with private insurance or non-VFC eligible Medicaid plans, or VFC supply for VFC-eligible patients. VFC supply and commercial supply were labeled differently and stored separately. Upon receipt of an order, the pharmacist double-checked that the correct product was selected and documented this as an intervention in the EHR.
Finally, we calculated the theoretical health outcomes that were prevented based on the number of immunizations we administered.3
For the 2025-2026 RSV season, 4,079 doses of nirsevimab were administered to infants and children in our health system. Of these, 1,645 doses were administered to patients who qualified for the VFC program and were available at no cost to our health system. The overall cost avoidance due to participation in the VFC program was $822,500.
A review of our reimbursements revealed that 82% of our patients either had insurance (commercial or Medicaid) that reimburses the health system for administration or made them eligible for VFC supply. An additional 10% of patients had insurance plans that agreed to provide a nominal increase to per-birth diagnosis related group (DRG) payments. The result is that we did not receive reimbursement for only 8% of our patients.
We estimate that our program prevented 240 outpatient visits, 85 emergency department visits, 32 hospital admissions, and 7 intensive care unit admissions for the 2025-2026 season.
Enrollment of birthing hospitals in VFC is an innovative approach to improve vaccine access to newborns while controlling costs. This in combination with DRG reimbursement negotiation for insured infants allowed our health system to offer RSV immunizations in a financially sustainable model.
References
- American Academy of Pediatrics Immunization Schedule, 2026. Available at: https://www.aap.org/ImmunizationSchedule?srsltid=AfmBOoq0MAaEPfbmCyXq794NJrsORFDIhpbmeXmBMcq-KiMpOBRySruz Accessed October 12, 2026.
- Vaccines. New Jersey Department of Health. https://www.nj.gov/health/vaccines/programs/vfc/providers/ Accessed July 9, 2026.
- O’Leary ST, Yonts AB, Gaviria-Agudelo C, Kimberlin DW, Paulsen GC. Summer 2023 ACIP Update: RSV Prevention and Updated Recommendations on Other Vaccines. Pediatrics. 2023;152(5):e2023063955.
Top row: Rachel Meyers, Jessica Lise
Bottom row: Kathleen Rivera, Douglas DeStefano