Synagis

Human Respiratory Syncytial Virus (RSV) causes respiratory tract infections and serious lung disease in infants and children. Synagis (palivizumab) is available for children with high risk of infection.

HHSC bases RSV season dates on the county of residence. RSV appears earlier in some counties and remains active later in other counties. HHSC uses RSV statistics from previous years plus regular virology reports to determine the season's dates for each region and reserves the right to extend or end a season after subsequent review of RSV levels in each region. MCO medical directors can end the RSV season for their MCO by service area if they demonstrate the local virology has dropped below 10% positivity for two consecutive weeks.

Season Schedule

HHSC publishes the current RSV season on the VDP website, broken out by Texas public health region. Providers can find their region using the interaction region map (PDF) and selecting the buttons marked HHS regions and county names.

Pharmacy Information

Any specialty pharmacy enrolled with HHSC may provide Synagis. A pharmacy must enroll in the CSHCN Services Program to provide services to children in the program.

Traditional Medicaid

Prior authorization is a two-step process. The prescribing provider completes the following forms and submits them along with the prescription for Synagis and any supporting information to the Medicaid-enrolled pharmacy.

  • Standard Prior Authorization Request
  • Synagis Standard Prior Authorization Addendum (HHSC Form 1321)

Refer to the Prior Authorization Requests section for the forms. Failure to submit both forms will result in an authorization denial or delay.

Pharmacy providers then submit the form to the Texas Prior Authorization Call Center.

Medicaid managed care and CHIP

Pharmacy providers should contact the client's specific MCO for prior authorization requirements and forms. MCOs may require further information in addition to the MCO-specific addendum form. An MCO’s addendum form will reflect the MCO's contact information and reconsideration request process.

CSHCN Services Program

Prior authorization is a two-step process. The prescribing provider completes the following forms and submits them along with the prescription for Synagis and any supporting information to the CSHCN-enrolled pharmacy.

  • Standard Prior Authorization Request
  • Synagis Standard Prior Authorization Addendum (HHSC Form 1325)

Refer to the Prior Authorization Requests section for the forms. Failure to submit both forms will result in an authorization denial or delay.

Pharmacy providers then submit the form to the CSHCN Services Program.