August 31, 2018
The 2018-19 Respiratory Syncytial Virus (RSV) season begins Oct. 1 for many counties in Texas:
- The schedule is staggered and is based on a patient's county of residence at the start of the RSV season. Refer to the RSV Season Schedule for each region’s start and end dates.
- Prior authorization forms and instructions for each program are available.
- The option to purchase and bill through TMHP is not available this season.
Requests for Traditional Medicaid
- Providers will obtain Synagis through the Vendor Drug Program, and may begin using the Medicaid Synagis Authorization Request (Form 1033) on September 17. To obtain prior authorization, the prescriber must complete the 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 can call the Texas Prior Authorization Center at 1-877-728-3927 for assistance with request forms.
Requests for Medicaid managed care
- Providers should contact the person’s managed care health plan for prior authorization forms and instructions. Contact information is available on the Prescriber MCO Assistance Chart (PDF), or refer to the MCO Resources for links to each health plan's clinical prior authorizations.
Requests for the Children with Special Health Care Needs Services Program
- Providers will obtain Synagis through the CSHCN Services Program, and should use CSHCN Services Program Synagis Authorization Request (Form 1055). Providers can call the CSHCN Services Program at 1-800-252-8023 for questions related to submitting forms.