August 30, 2019
The 2019-2020 respiratory syncytial virus (RSV) season begins Oct. 1. The Vendor Drug Program will accept prior authorization requests for Synagis starting Sept. 9. The prior authorization criteria, request forms and season schedule are available.
For Fee-For-Service Medicaid
The prescribing provider must send the completed form to the dispensing pharmacy. Pharmacy staff will 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 help with the form.
For Medicaid Managed Care
Providers must contact their patient’s MCO for prior authorization forms and instructions. Phone, email, and web address information for each MCO is available on the Prescriber MCO Assistance Chart (PDF).
For the CSHCN Services Program
Providers can call the CSHCN Services Program at 1-800-252-8023 for help with the form.