Respiratory Syncytial Virus (RSV) Prophylaxis Season Reopening Across All Regions

May 25, 2022

The Texas Health and Human Services Commission (HHSC) is aware of a summertime RSV resurgence in multiple regions across the state. In response to this RSV activity and consultation with medical experts from across the state, HHSC will take necessary action to prevent the further spread of RSV by reopening all regions to monthly administration of palivizumab (Synagis) prophylaxis to eligible members, starting June 1, 2022. Providers may start monthly palivizumab (Synagis) prophylaxis treatment for all eligible members beginning as early as June 1.

Based on a higher RSV positivity rate in regions 3 and 6, HHSC has encouraged Medicaid managed care organizations (MCOs) to allow access earlier than June 1 if administratively possible. Pharmacy providers should contact the client's specific MCO for details.

A new prior authorization request is required for all members who meet the criteria for RSV prophylaxis . Per HHSC policy and RSV guidelines, members should receive one dose per month, up to five doses per treatment course.

MCO medical directors can end the RSV season for their given service area if data is submitted to HHSC to indicate the local polymerase chain reaction test virology has dropped below 3% positivity for two consecutive weeks. At this time, it is not possible to anticipate how this summertime RSV activity will impact the traditional 2022-23 RSV season. HHSC will continue to monitor all regions to provide further guidance as the RSV season progresses.

Forms and contacts

Managed Care (Medicaid, CHIP)

Traditional Medicaid

CSHCN Services Program