Coverage

Use the Coverage Tool to get real-time information about formulary coverage for AREXVY in your area.

Patient Access to AREXVY

  • Medicare Part D:
    Per the Inflation Reduction Act, ACIP-recommended vaccines are covered at $0.1*†‡
  • Commercial:
    Per the Affordable Care Act, commercial plans are required to cover vaccination in accordance with ACIP recommendations at $0 when administered in-network.2†‡

 

Address patient questions about cost and ensure insurance benefits are verified.
Available at all major pharmacy retailers in the United States.§

For additional questions about billing, coding, and reimbursement for GSK vaccines, visit the GSK Vaccines Reimbursement Support Center or contact the Support Center:

Phone icon

Phone: 1-855-636-8291     Fax: 1-877-683-1329

Monday – Friday 8:00 am – 8:00 pm ET

  • *

    For Medicare Part D patients (pharmacy benefit), AREXVY may be administered at an in- or out-of-network retail pharmacy. Prescribers enrolled in a web-assisted portal for Medicare Part D vaccines administered in-office may electronically submit out-of-network claims to Medicare Part D plans for AREXVY.3

  • The distinction between routine recommendations and risk-based recommendations can affect coverage under these plans.

  • Coverage, coding, cost to patient, reimbursement amount for product, and administration fee will vary by payer, plan (including whether your patient is covered by Medicare or commercial insurance), patient, professional setting, or services rendered, and are subject to change without notice. Cost to patients may vary. Coverage and reimbursement decisions are made by individual insurance plans following receipt of claims from providers. Providers must follow documentation and billing requirements of payer.

  • §

    Stocking at individual stores may vary.

Indication & Important Safety Info

Indication

Important Safety Information

Indication

AREXVY is a vaccine indicated for active immunization for the prevention of lower respiratory tract disease (LRTD) caused by respiratory syncytial virus (RSV) in:

  • individuals 60 years of age and older;
  • individuals 50 through 59 years of age who are at increased risk for LRTD caused by RSV.

Important Safety Information

  • AREXVY is contraindicated in anyone with a history of a severe allergic reaction (eg, anaphylaxis) to any component of AREXVY
  • The results of a postmarketing observational study suggest an increased risk of Guillain-Barré syndrome during the 42 days following vaccination with AREXVY
  • Appropriate medical treatment must be immediately available to manage potential anaphylactic reactions following administration of AREXVY
  • Syncope (fainting) may occur in association with administration of injectable vaccines, including AREXVY. Procedures should be in place to avoid injury from fainting
  • Immunocompromised persons, including those receiving immunosuppressive therapy, may have a diminished immune response to AREXVY
  • In adults 60 years of age and older, the most commonly reported adverse reactions (≥10%) were injection site pain (60.9%), fatigue (33.6%), myalgia (28.9%), headache (27.2%), and arthralgia (18.1%)
  • In adults 50 through 59 years of age, the most commonly reported adverse reactions (≥10%) were injection site pain (75.8%), fatigue (39.8%), myalgia (35.6%), headache (31.7%), arthralgia (23.4%), erythema (13.2%), and swelling (10.4%)
  • There are no data on the use of AREXVY in pregnant or breastfeeding individuals. AREXVY is not approved for use in persons <50 years of age
  • Vaccination with AREXVY may not result in protection of all vaccine recipients

 

Please see full Prescribing Information.

To report SUSPECTED ADVERSE REACTIONS, contact GSK at gsk.public.reportum.com or
1-888-825-5249, or VAERS at 1-800-822-7967 or www.vaers.hhs.gov.

ACIP=Advisory Committee on Immunization Practices; CDC=Centers for Disease Control and Prevention; RSV=respiratory syncytial virus.

References

  1. Final contract year 2024 Part D bidding instructions. Centers for Medicare & Medicaid Services. Accessed July 31, 2024. https://www.cms.gov/files/document/final-cy-2024-part-d-bidding-instructions.pdf
  2. Affordable Care Act implementation FAQs - Set 12. Centers for Medicare & Medicaid Services. Accessed July 31, 2024. https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/aca_implementation_faqs12
  3. MLN fact sheet: Medicare Part D vaccines. Centers for Medicare & Medicaid Services. Accessed June 28, 2024. https://www.cms.gov/files/document/mln908764-medicare-part-d-vaccines.pdf

Questions About AREXVY?

Call: 1-877-AREXVY1 (1-877-273-9891) Available Monday - Friday 8:30 am - 5:30 pm ET