September 19, 2017

Prior authorization requests for Synagis (palivizumab) will be accepted by fax and processed beginning September 19 for people enrolled in fee-for-service Medicaid and Children with Special Health Care Needs (CSHCN) Services Program. Prior authorization effective dates are based on the person’s county of residence at the start of the season. The first regional start date begins October 1. Please reference the 2017-18 schedule for a complete listing of season start dates.  The option to purchase and bill through TMHP is not available for this season. 

Fee-For-Service (FFS) Medicaid

Prescribing providers must obtain Synagis through the Vendor Drug Program. Providers may begin using the Medicaid Synagis Prior Authorization form on September 19.  To obtain prior authorization, the prescriber must complete the prior authorization form and send it to the dispensing pharmacy.  Pharmacy staff will then fax the form to the Texas Prior Authorization Call Center for processing.  Providers may call the Texas Prior Authorization Center at 1-877-728-3927 for questions.

Medicaid managed care

MCOs are required to adopt the same criteria as fee-for-service. Providers should contact the person’s MCO for forms and instructions.  Please refer to the Prescriber Assistance Chart (PDF) for client and prior authorization call center phone numbers.

CSHCN Services Program

Prescribing providers must obtain Synagis through the CSHCN Services Program for eligible people, and utilize the CSHCN Services Program Synagis Prior Authorization form.   Providers may call the CSHCN Services Program at 1-800-252-8023 for questions.