Three FDA-approved vaccines protect adults against respiratory syncytial virus (RSV): Abrysvo from Pfizer, Arexvy from GlaxoSmithKline, and mRESVIA from Moderna. Abrysvo and Arexvy are recombinant prefusion F protein subunit vaccines that the FDA approved in May 2023, while mRESVIA is an mRNA-platform vaccine the FDA approved in May 2024. Abrysvo carries an additional maternal indication: a single dose given to pregnant patients between 32 and 36 weeks of gestation to protect newborns during their first six months of life. All three products require only a single intramuscular dose for eligible adults, and revaccination is not currently recommended.
Cash retail prices for the RSV vaccine run approximately $300 to $385 per dose in 2026, based on GoodRx pharmacy surveys and the CDC's published private-sector vaccine price list. GoodRx reports 2026 average retail prices of $361.73 for Abrysvo, $374.43 for Arexvy, and $374.06 for mRESVIA, with GoodRx-coupon prices as low as $321 to $327 at participating pharmacies. Medicare Part D beneficiaries and most commercially insured adults in the ACIP-recommended group pay $0 for the vaccine product itself, though a separate office-visit or administration charge sometimes appears on the bill. Uninsured adults face the full cash price unless they qualify for a manufacturer patient assistance program, a community health center's sliding-scale fee, or a state immunization clinic.
The Advisory Committee on Immunization Practices expanded its RSV vaccine recommendation in 2025, lowering the eligible age for high-risk adults from 60 to 50. As of the 2025-2026 respiratory virus season, ACIP recommends a single lifetime dose for all adults 75 and older and for adults 50 to 74 who have qualifying risk factors such as chronic heart or lung disease, diabetes, or a weakened immune system. The RSV vaccine is separate from Beyfortus (nirsevimab), a monoclonal antibody given to infants and some toddlers to prevent severe RSV disease; Beyfortus is not a vaccine and has its own pricing and coverage rules. Unlike Eliquis or Jardiance, the RSV vaccine was not selected for Medicare's Maximum Fair Price negotiation under the Inflation Reduction Act. Instead, the relevant IRA provision eliminated Medicare Part D cost-sharing for ACIP-recommended vaccines starting January 1, 2023, which is why most Medicare beneficiaries pay nothing for this shot.
What RSV Vaccine Costs by Point of Pay (2026)
The price you pay depends almost entirely on WHERE you pay. The same rsv vaccine can cost many times more at a hospital than at your local pharmacy:
2026 RSV Vaccine Price by Point of Pay| Where you pay | Typical cost | Notes |
|---|
| Pharmacy counter (retail, cash) | $300 - $385/dose | 2026 GoodRx average retail price without insurance or a PAP |
| Medicare Part D (2026) | $0 for ACIP-eligible adults | Ages 75+, or 50-74 with qualifying risk factors, under the IRA's $0 vaccine benefit |
| Commercial insurance | $0 in-network for ACIP group; full cash price otherwise | Covered as an ACA preventive service when given in-network to an eligible adult |
| Manufacturer patient assistance program | Free for uninsured adults at or below ~300% FPL | Pfizer RxPathways (Abrysvo) and GSK Vaccines PAP (Arexvy); provider-submitted enrollment |
| Medicaid | $0 - $4/dose | Covered adult vaccine benefit; exact copay and formulary rules vary by state |
Retail prices reflect 2026 GoodRx and CDC private-sector vaccine price list data. Medicare Part D and most in-network commercial coverage reduce the cost to $0 for adults who meet ACIP's age and risk-factor criteria.
Source: CDC Adult Vaccine Price List (2026), CMS Inflation Reduction Act Part D vaccine benefit, GoodRx, Pfizer RxPathways, GSK Vaccines Patient Assistance Program
Why Hospitals Charge So Much
Hospitals rarely administer the RSV vaccine as a standalone service outside seasonal immunization clinics, but the vaccine sometimes appears on a bill when a high-risk patient receives it during an inpatient stay or an emergency department visit. Facility charges in that setting typically stack the vaccine product cost, a separate administration fee, and a general facility or clinic visit fee on top of each other, pushing the total well above the $300 to $385 cash-pay range seen at retail pharmacies in 2026.
Patients who see an RSV vaccine charge above $500 on a hospital bill should request an itemized statement showing the CPT vaccine product code, either 90678 for Abrysvo, 90679 for Arexvy, or 90683 for mRESVIA, along with the separate administration code. Comparing that itemized charge to the 2026 CDC private-sector price of roughly $291 to $307 per dose helps identify facility markup. Medicare Part D and most commercial plans will only reimburse the covered vaccine benefit rate, which for ACIP-eligible patients is $0 out-of-pocket, leaving any inflated facility markup as a target for a billing dispute or an itemized-bill request under the No Surprises Act's good-faith-estimate protections.
Patient Assistance Programs
Pfizer, GSK, and Moderna each run a patient support program for their respective RSV vaccine. These programs matter most for uninsured adults, since Medicare Part D, Medicaid, and most in-network commercial plans already cover the vaccine at $0 for ACIP-eligible patients. For someone with no insurance facing the full $300 to $385 cash price, the manufacturer program can reduce the cost to $0.
Patient assistance programs for RSV Vaccine| Manufacturer program | Cost / Benefit | How to apply |
|---|
| Pfizer RxPathways (Abrysvo Vaccine Assistance) | Free Abrysvo for uninsured adults with household income at or below approximately 300% of the federal poverty level in 2026 | pfizerrxpathways.com |
| GSK Vaccines Patient Assistance Program (Arexvy) | Free Arexvy for uninsured adults; the 2026 limit is $47,880 for a household of one in 48 states and DC (higher in Alaska and Hawaii) | gskforyou.com/programs/patient-assistance-program |
| Moderna Patient Support (mRESVIA) | Case-by-case assistance and referrals for uninsured patients; Moderna has not published a dedicated income-gated PAP for mRESVIA as of 2026 | modernatx.com |
| NeedyMeds RSV Vaccine Assistance Finder | Directory of state Vaccines-for-Adults programs, community health center sliding-scale clinics, and manufacturer assistance | needymeds.org |
Federal anti-kickback statute (42 U.S.C. § 1320a-7b) bars manufacturers from offering copay coupons to Medicare, Medicaid, TRICARE, or VA beneficiaries. That rule matters less here than for chronic-disease drugs, because the Inflation Reduction Act already requires $0 cost-sharing for ACIP-recommended vaccines like this one under Medicare Part D. If you have government insurance and are still billed for the vaccine, ask your pharmacy or provider to rebill it as a $0 Part D vaccine claim instead of applying for manufacturer assistance.
Source: Pfizer RxPathways, GSK Vaccines Patient Assistance Program (GSKPAF), Moderna patient support, NeedyMeds.org
Medicare Part D
Medicare Part D has covered the RSV vaccine at $0 cost-sharing since January 1, 2023, under the Inflation Reduction Act of 2022, which eliminated deductibles, copays, and coinsurance for every ACIP-recommended adult vaccine. That $0 benefit applies whether a Part D enrollee gets Abrysvo, Arexvy, or mRESVIA at a retail pharmacy, at a doctor's office that bills through the Part D pharmacy benefit, or at a health department clinic. You can check your own Medicare eligibility before your appointment to confirm which benefit period applies.
The Advisory Committee on Immunization Practices recommends the RSV vaccine as a single lifetime dose for Medicare-age adults 75 and older, and for adults 50 to 74 with qualifying risk factors like chronic obstructive pulmonary disease, heart failure, diabetes, or a weakened immune system. Medicare beneficiaries outside those criteria who still want the vaccine can typically get it, but some Part D plans may apply a formulary tier restriction, require prior authorization, or require the prescriber to document medical necessity before paying the $0 benefit. ACIP-eligible patients almost never need prior authorization.
Medicare Advantage plans that bundle Part D drug coverage must follow the same $0 cost-sharing rule for ACIP-recommended vaccines in 2026. Beneficiaries who are billed anything above $0 for an eligible RSV vaccine dose should ask their pharmacy or provider to rebill the claim under the correct Part D vaccine benefit before paying out of pocket, and can compare an unexpected charge against the Medical Bill Analyzer for a second check.
Common RSV Vaccine Billing Errors
Patients billed for the RSV vaccine above $0 on Medicare Part D, or above $50 with commercial insurance for an in-network, ACIP-eligible dose, should check for these common 2026 billing problems before paying:
- Vaccine billed as a medical-benefit claim instead of a Part D pharmacy claim, causing the plan to apply a deductible or coinsurance that should not apply under the IRA's $0 vaccine benefit.
- Wrong CPT vaccine product code submitted, 90678 for Abrysvo, 90679 for Arexvy, or 90683 for mRESVIA, which can trigger a coverage denial if it does not match the NDC on the actual dose given.
- Administration fee billed separately at an inflated facility rate when the vaccine was given in a hospital outpatient department rather than a pharmacy or primary care office.
- Patient outside the ACIP-recommended age or risk-factor group billed the full cash price without being told that a documented risk factor or formulary exception could unlock $0 coverage.
- Abrysvo billed under a non-maternal product code for a pregnant patient receiving the maternal RSV vaccine indication, or the reverse.
- Manufacturer patient assistance program eligibility not checked before an uninsured patient pays the full $300 to $385 cash price at the pharmacy counter.
Frequently Asked Questions
Is there a generic or biosimilar RSV vaccine?
No. As of 2026 there is no generic or biosimilar RSV vaccine. Abrysvo, Arexvy, and mRESVIA are three separately licensed biologics from Pfizer, GSK, and Moderna, each protected by 12-year biologics exclusivity under federal law. Because Arexvy and Abrysvo were licensed in 2023 and mRESVIA in 2024, biosimilar competition is not expected before roughly 2035. If cost is the concern, compare the three brands, since prices and coverage rules differ slightly between them.
How do I apply for the Pfizer RxPathways or GSK patient assistance program for the RSV vaccine?
Start at pfizerrxpathways.com for Abrysvo or gskforyou.com for Arexvy, or call the program directly (Pfizer RxPathways: 1-844-989-PATH; GSK Vaccines PAP: 1-866-728-4368). Confirm you have no vaccine coverage and are not on Medicare, since Medicare Part D already covers the vaccine at $0. Have your provider submit the enrollment form with proof of income, US residency, and a vaccine order, since most manufacturer vaccine PAPs are provider-submitted rather than filed directly by the patient.
Can I use a manufacturer coupon or savings card for the RSV vaccine if I have Medicare?
You generally will not need one. Medicare Part D covers the RSV vaccine at $0 cost-sharing for ACIP-eligible adults under the Inflation Reduction Act, effective since January 1, 2023. Federal anti-kickback law also bars manufacturers from offering copay coupons to Medicare, Medicaid, TRICARE, or VA beneficiaries in any case. If you are billed for the vaccine on Medicare, ask your pharmacy to rebill it as a $0 Part D vaccine claim rather than looking for a manufacturer coupon.
What if my insurance denies coverage for the RSV vaccine?
Request the written denial notice and check whether it cites your age or missing risk-factor documentation. File a formal appeal within 60 days, and ask your prescriber to submit records showing you meet ACIP's criteria (50 to 74 with a qualifying condition, or 75 and older). If your plan only stocks one brand, ask for a formulary exception. If the appeal fails, apply to the Pfizer RxPathways or GSK Vaccines Patient Assistance Program instead.
Does the IRA negotiated Maximum Fair Price apply to the RSV vaccine?
No. The Inflation Reduction Act's Maximum Fair Price negotiation program covers ten chronic-disease prescription drugs, such as Eliquis and Jardiance, with negotiated prices effective January 1, 2026. Vaccines, including the RSV vaccine, were not selected for that program. The IRA provision that does apply here eliminated Medicare Part D cost-sharing for all ACIP-recommended adult vaccines starting January 1, 2023, which is why most Medicare patients pay $0 for the RSV vaccine instead of a negotiated price.
What does the RSV vaccine cost without insurance at the pharmacy in 2026?
The 2026 cash price runs about $300 to $385 per dose. GoodRx reports average retail prices of $361.73 for Abrysvo, $374.43 for Arexvy, and $374.06 for mRESVIA, with coupon prices as low as $321 to $327 at some pharmacies. Costco and Kroger pharmacies tend to price closer to the CDC's private-sector cost of roughly $290 to $307 per dose, while Walgreens and standalone retail pharmacies often run higher without a discount card.
Do I qualify for the Pfizer or GSK patient assistance program for the RSV vaccine?
You likely qualify if you are uninsured for vaccines, a US or Puerto Rico resident, and your household income is at or below about 300% of the federal poverty level in 2026, roughly $47,880 for one person or $99,000 for a household of four. Medicare and Medicaid enrollees do not need these programs because their coverage already pays $0 for the vaccine. Check the exact 2026 threshold for your household size before applying.
What is the difference between Abrysvo, Arexvy, and mRESVIA, and how is the RSV vaccine different from Beyfortus?
Abrysvo (Pfizer) and Arexvy (GSK) are recombinant protein vaccines approved in 2023; mRESVIA (Moderna) is an mRNA vaccine approved in 2024. Abrysvo is the only one also approved for pregnant patients to protect newborns. All three are single-dose adult vaccines with comparable efficacy against severe RSV disease. Beyfortus (nirsevimab) is a different product entirely: a monoclonal antibody injection given to infants and some toddlers, not a vaccine, and it has separate pricing and coverage rules.
