2024–25 RSV Season and Synagis Prior Authorization Begins for State Health Regions

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Human Respiratory Syncytial Virus (RSV) causes respiratory tract infections and severe lung disease in infants and children. Synagis (palivizumab) is available for children with a high risk of infection.

The Texas Pediatric Society's RSV Task Force recommended the Texas Health and Human Services Commission open the 2024-25 monthly prophylaxis for RSV on Oct. 1, 2024. Review the schedule for each region's start and end dates.

Prescribing providers must prescribe Synagis to infants meeting the criteria described on the American Academy of Pediatrics website. The option to purchase and bill Synagis vials through TMHP is not available.

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 (fee-for-service) Medicaid

Prescribing providers can obtain Synagis prescribed for a specific infant from participating pharmacies through VDP using the Medicaid Synagis Authorization Addendum (HHS Form 1321) on the following dates:

  • Sept. 23 for state health service regions 5 and 6
  • Oct. 1 for state health service regions 7 and 11
  • Oct. 15 for state health service regions 3, 4, and 8
  • Oct. 29 for state health service regions 1, 3, 9, and 10

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.

Children with Special Health Care Needs Services Program

Providers obtain Synagis through the CSHCN Services Program and should use the CSHCN 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.