Abrysvo vs Beyfortus vs Enflonsia (2026-27): Which One Your Baby Needs, What It Costs and What to Do If Insurance Won't Pay

By Sofía Castillo•Published October 24, 2026

Abrysvo vs Beyfortus isn't really a contest: they're two routes to the same goal, keeping your newborn out of the hospital with RSV this winter. Abrysvo is a single vaccine you get late in pregnancy. Beyfortus (nirsevimab), or the newer Enflonsia (clesrovimab), is an antibody shot your baby gets after birth. Most babies need one route, not both. For 2026-27, two things changed that most pages haven't caught up with: ACOG stretched the Abrysvo window to September 1 through March 1, and many families are learning that their insurer won't pay for the baby's shot while you're still in the hospital.

Below you'll find a side-by-side comparison, a due-date table to see which option fits you, the real list prices, and a script for your hospital, pediatrician and insurer so your baby doesn't leave unprotected. Everything comes from ACOG, AAP, AAFP, CDC and FDA documents, linked at the end.

The short answer

• Pregnant and between 32 and 36 weeks from September 1 to March 1? You can get one dose of Abrysvo. If your baby is born at least 14 days later, they usually don't need an antibody shot.
• Skipped the vaccine, got it less than 14 days before delivery, or got it in a past pregnancy? Your baby should get Beyfortus or Enflonsia, ideally before leaving the hospital and within the first week of life.
• Beyfortus or Enflonsia? AAP and AAFP don't prefer either one for the first season. ACOG advises choosing whichever is "most readily available and easily accessible."
• List prices (October 2026): Abrysvo $319.07; Enflonsia $556; Beyfortus $556.13 to $595.06 per dose, depending on the source.
• Biggest 2026 trap: many insurers don't pay hospitals for the antibody during the birth stay, even though they pay for it at the pediatrician's office days later. Ask before you deliver.

Abrysvo vs Beyfortus vs Enflonsia: side-by-side comparison

Here's how the three options compare on the details parents ask about most. Efficacy numbers come from each product's own trials, which used different designs, so they can't be ranked against each other directly.

Sources for the table: ACOG 2026-27 guidance, AAFP 2026-27 RSV recommendations, the FDA Abrysvo approval, the FDA Enflonsia trial snapshot and the CDC price list. Synagis (palivizumab), the old monthly shot, has been discontinued; Beyfortus now covers the high-risk babies who used to get it.

Which option fits your due date?

The deciding factor is where your 32-to-36-week stretch lands. If any day of it falls between September 1, 2026, and March 1, 2027, Abrysvo is an option. If not, plan on the antibody for your baby. Use this table, then confirm with your OB.

Seasonal timing can be different in Alaska, Hawaii, Puerto Rico and other areas with a different RSV pattern, so follow your state or territory's guidance if you live there.

Why ACOG extended the Abrysvo window to March 1

On September 2, 2026, ACOG updated its guidance so pregnant patients can get Abrysvo from September 1 through March 1, instead of stopping on January 31. The reason: recent RSV seasons have run later into spring and have been more severe. Practically, if you're due in late March or early April 2027, you may now qualify when you wouldn't have last year.

ACOG also repeated two rules that trip people up. First, it's one dose for life for now, because there's no data on how well a repeat dose works in a later pregnancy. Second, Abrysvo is the only RSV vaccine approved for use in pregnancy, so the Arexvy and mResvia shots for older adults are not substitutes. Only about 41.6% of eligible pregnant patients got the maternal vaccine last season, according to ACOG.

Is the RSV vaccine safe in pregnancy?

Abrysvo's FDA label lists injection-site pain (40.6%), headache (31.0%) and muscle pain (26.5%) as the most common side effects in pregnant participants. The label also carries a warning about a numerical imbalance in preterm births in the trials: 5.7% with Abrysvo vs 4.7% with placebo. The FDA said the data couldn't establish or rule out a link, which is why the vaccine is given only from 32 weeks on.

Since approval, AAFP reports that post-authorization evidence has not shown a higher risk of preterm birth with the recommended timing. The label's Guillain-Barré warning comes from studies in older adults, and AAFP notes it has not been reported after maternal vaccination. If you have a history of severe allergic reaction to a vaccine ingredient, or a high risk of preterm birth, talk it through with your OB; going straight to the antibody for your baby is an equally recommended path.

For the baby's antibodies, AAFP says side effects are usually mild, such as pain, redness or swelling where the shot was given. Babies with a moderate or severe illness generally wait until they recover. Either antibody can be given at the same visit as routine vaccines.

Beyfortus vs Enflonsia: is one better?

For a baby's first RSV season, neither the AAP nor AAFP prefers one product over the other. The practical differences are small but real:

• Dosing: Enflonsia is one 105 mg dose for every baby. Beyfortus is dosed by weight (50 mg under 5 kg, 100 mg at 5 kg or more), which matters mostly for late-season catch-up shots.
• Second season: only Beyfortus is approved for high-risk toddlers 8 through 19 months. If your baby was very premature or has a heart or lung condition, the clinic may stock Beyfortus for that reason.
• Evidence base: Beyfortus has been used since the 2023-24 season, with real-world data showing strong protection against RSV emergency visits and hospitalizations. Enflonsia was approved in June 2025.
• Availability: this often decides it. A hospital or practice may stock only one product; ACOG's advice is to use whichever is readily available, rather than delay.

How much does Abrysvo cost? How much is Beyfortus?

These are the private-sector list prices that manufacturers report. What you actually owe depends on your insurance, where the shot is given and any administration fee, which is billed separately.

Coverage is better than those numbers suggest. Under the Affordable Care Act, most private plans must cover immunizations recommended on the federal schedule with no cost sharing in-network, and KFF notes that requirement was expanded in 2025 to include Enflonsia. AHIP, the insurers' trade group, says its member plans will keep covering ACIP-recommended immunizations with no cost sharing through the end of 2027. Medicaid also covers recommended adult vaccines, including Abrysvo in pregnancy, without cost sharing.

If your baby is uninsured, on Medicaid, American Indian or Alaska Native, or underinsured, the Vaccines for Children (VFC) program supplies Beyfortus and Enflonsia for free; underinsured children get VFC doses at federally qualified or rural health centers. Abrysvo itself is on the VFC list too, which helps if you're pregnant and 18 or younger. A VFC office can charge a modest administration fee but can't turn your child away if you can't pay it.

What to do if insurance won't pay for the RSV shot in the hospital

This is the problem nobody explains well. As NPR reported on October 16, 2026, many hospitals don't give newborns the RSV antibody before discharge because most commercial insurers don't reimburse them for it. Birth stays are paid as a bundle that usually doesn't include a $500 shot, and AHIP told NPR that plans aren't required to pay for it in the hospital, only in doctors' offices. AAP News adds that only 36% of birthing hospitals were enrolled in VFC as of spring 2025, and that some hospitals skip the shot for every baby rather than offer it to some families and not others.

The risk is the gap between discharge and the first checkup. The AAP News report describes a 2-week-old who caught RSV in exactly that window and spent 12 days in the hospital. Here's how to close the gap.

Before you deliver: four questions for the hospital

1. "Do you give nirsevimab (Beyfortus) or clesrovimab (Enflonsia) to newborns before discharge during RSV season?"
2. "Is it covered by my plan here, or billed separately? Will I get a bill for it?"
3. "Are you enrolled in the Vaccines for Children program?" (This matters if your baby will be on Medicaid or uninsured.)
4. "If you don't give it, can you note it in the discharge papers so the pediatrician knows?"

Call your insurer with the billing codes

Insurance reps answer faster when you give them codes. According to the AAP coding guide, ask whether your plan covers these, both in the hospital and at the pediatrician's office:

• 90380: nirsevimab 0.5 mL (Beyfortus 50 mg)
• 90381: nirsevimab 1 mL (Beyfortus 100 mg)
• 90382: clesrovimab 0.7 mL (Enflonsia)
• 96380 or 96381: administration of the antibody, with or without counseling
• Z29.11: the diagnosis code for RSV prophylaxis (not Z23, which is for vaccines)
• For your own Abrysvo shot, ask about the vaccine and its administration code, and confirm the OB office or pharmacy is in-network.

Book the first pediatric visit for days 3 to 5

If the hospital won't give it, the antibody should be given within the first week of life. Choose a pediatrician before delivery, call to confirm they stock Beyfortus or Enflonsia, and book the newborn visit for the first few days after discharge. Ask the hospital to send your Abrysvo record (or the fact that you didn't get it) so nobody has to guess.

If you get a bill or a denial

1. Ask the hospital for an itemized bill and check whether the shot was coded with the codes above.
2. Ask your insurer for the denial in writing. Insurers have to explain the reason.
3. File an internal appeal within 180 days of the denial. A letter from your pediatrician helps; HealthCare.gov explains the process.
4. If the appeal fails, request an external review. Your state's Consumer Assistance Program can help you file for free.
5. Ask your pediatrician's office to report the denial to the AAP's coding hotline, which is tracking denial patterns to press insurers.

Packing your hospital bag for RSV season

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No product replaces the shot, but a few things make the first winter weeks calmer. Add these to your hospital bag or nursery basket:

• Your vaccine record. A photo of your Abrysvo record (date included) saves the pediatrician a phone call.
• A digital thermometer you can use rectally. For babies under 3 months, the AAP says a rectal temperature of 100.4°F (38°C) or higher means calling the doctor right away. A baby digital thermometer is the most reliable way to check.
• Saline drops and a nasal aspirator. Babies breathe through their noses, and the AAP recommends saline drops followed by gentle suction to clear mucus. A saline and nasal aspirator kit covers both.
• Hand sanitizer for visitors. RSV spreads on hands and surfaces, so keep a pack of travel hand sanitizers by the door and in the diaper bag.

When to call the doctor about RSV symptoms

Even a protected baby can catch RSV; the shots make severe illness much less likely, not impossible. In babies under 6 months, the CDC says RSV may show up only as irritability, less activity, poor feeding or pauses in breathing, sometimes without a fever. Call your pediatrician promptly if your baby:

• Is feeding much less than usual or has fewer wet diapers
• Has a rectal temperature of 100.4°F (38°C) or higher and is under 3 months old
• Has a cough or runny nose that keeps getting worse

Call 911 or go to the emergency room for fast, shallow or labored breathing, skin pulling in between the ribs, flaring nostrils, pauses in breathing, or bluish or gray lips, skin or nails.

Frequently asked questions

This article is for general information, was last updated on October 24, 2026, and is not medical, billing or legal advice. Recommendations, prices and insurer policies change, and RSV timing can differ in Alaska, Hawaii, Puerto Rico and other areas, so confirm your plan with your OB, your baby's pediatrician and your insurer.

Sources

• ACOG: 2026-27 respiratory virus season immunization recommendations for pregnant and postpartum individuals (September 2, 2026)
• AAFP: Respiratory syncytial virus, 2026-27 recommendations
• AAP: RSV immunization products and ordering information, private sector cost (September 2, 2026)
• AAP: Coding and payment for RSV immunizations (September 2, 2026)
• AAP News: Lack of insurance coverage for RSV immunization in hospitals leaves newborns unprotected (September 14, 2026)
• NPR: Health insurers balk at paying for newborns' RSV immunization in the hospital (October 16, 2026)
• CDC: Vaccine price list, private sector and CDC contract prices (reviewed August 3, 2026)
• CDC: Vaccines for Children (VFC) program eligibility
• FDA: approval of Abrysvo for pregnant individuals to prevent RSV in infants
• FDA: Abrysvo prescribing information
• DailyMed: Beyfortus (nirsevimab) prescribing information
• FDA: Drug Trials Snapshots, Enflonsia (clesrovimab)
• NEJM: Nirsevimab for prevention of RSV in healthy late-preterm and term infants (MELODY trial)
• CDC ACIP: GRADE evidence review, nirsevimab season 1
• AHIP: statement on vaccine coverage (updated May 2026)
• KFF: recent changes in federal vaccine recommendations and insurance coverage
• HealthCare.gov: internal appeals
• CDC: RSV in infants and young children
• HealthyChildren.org (AAP): treating bronchiolitis in infants
• HealthyChildren.org (AAP): fever and your baby

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