Synagis Prior Authorization Begins Oct. 2 For Lower South Texas

The Texas Pediatric Society's respiratory syncytial virus (RSV) task force detected a trend of positive tests for RSV in lower south Texas. As a result, the Texas Health and Human Services Commission will start the 2023-24 monthly prophylaxis for RSV on Oct. 2, 2023, for all counties in state health service region 11. 

Refer to the season schedule for start dates and the regional map.

Prescribing providers must prescribe Synagis to infants meeting the criteria described on the American Academy of Pediatrics website. These criteria did not change from the 2022-2023 season.

The option to purchase and bill through TMHP is not available this season.

We will not open other areas at this time. HHSC will continue working with the Texas Pediatric Society's task force to determine the RSV prophylaxis schedule for the other regions and will provide additional instruction.

Prior Authorization Requests

For Medicaid Managed Care and CHIP 

Prescribing providers must contact the patient's MCO for prior authorization forms and instructions. You can use the MCO Search to find contact information for each MCO.

For Traditional Medicaid

Prescribing providers obtain Synagis prescribed for a specific infant from participating pharmacies through the Vendor Drug Program using the Medicaid Synagis Authorization Addendum (HHS Form 1321) on Sept. 25.

You 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. You can call the Texas Prior Authorization Center at 877-728-3927 for questions or assistance with the form.

For the Children with Special Health Care Needs Services Program

Providers obtain Synagis through the CSHCN Services Program and should use the CSHCN Services Program Synagis Prior Authorization Addendum (HHS Form 1325). Providers can call the CSHCN Services Program at 800-252-8023 for questions or assistance with the form.