Respiratory Syncytial Virus and Synagis Authorization During Summer and Winter 2021-22

Published on
August 25, 2021

The Texas Department of State Health Services (DSHS) monitors RSV activity year-round in its eleven public health regions and reports data on its website. This data is followed by the Health and Human Service Commission (HHSC) and the RSV Taskforce of practicing physicians from around the state. As a result of the recent summertime resurgence in RSV activity, HHSC began opening DSHS regions gradually from June 21 through July 23, 2021. With the traditional 2021-22 RSV season approaching, all Texas DSHS regions will remain open. All children who meet prior authorization criteria will be eligible for up to 5 monthly doses of Synagis (palivizumab).

On August 10, 2021, The American Academy of Pediatrics (AAP) issued interim guidance regarding the recent, unusual pattern of RSV activity observed across the United States. It supported reassessing the need for Synagis (palivizumab) for eligible children in regions with RSV activity as the fall-winter season approaches. Additionally, the AAP guidance also highlights the importance of maintaining a flexible approach to the unique and evolving nature of the current RSV situation.

During Texas's unusual summer RSV season, children who met age and clinical criteria have received monthly summertime doses of Synagis (palivizumab). Children who received doses of Synagis (palivizumab) during the summer RSV season will require reassessment as of October 1, 2021. Children who may require additional doses of Synagis (palivizumab) due to age, and clinical condition, will require completion of a new prior authorization process for possible additional doses.

HHSC will consider the traditional 2021-22 RSV season a new season beginning October 1, 2021, separate from the unusual summer season. Pharmacies must work with the individual MCO for approval for children with RSV infection risks not identified on the Medicaid RSV prior authorization form. The reconsideration process may require additional supporting documents, such as pertinent diagnostic, lab tests, or medical records.

At this time, it is not possible to anticipate if RSV activity will continue to spread equally in all regions or if it will increase to levels of activity typically seen during the fall and winter months. The RSV Season Schedule is available for reference. As new developments arise, it may be necessary to close certain regions based on the latest RSV activity reports. HHSC will continue monitoring RSV activity and engaging with DSHS and practicing physicians to provide further guidance as the RSV season progresses.