Human Respiratory Syncytial Virus (RSV) causes respiratory tract infections and serious lung disease in infants and children. Synagis (palivizumab) is available with prior authorization for high-risk patients.
The start and end of RSV season in Texas is based on the individual's county of residence. RSV appears earlier in some counties and remains active later in other counties. Texas HHS uses RSV statistics from prior years plus regular virology reports to determine the season's start and end dates for each region. HHS reserves the right to extend or end the season after subsequent review of RSV levels in each region.
Synagis will be active on the Texas Medicaid and Children with Special Health Care Needs (CSHCN) Services Program formulary beginning September 19, 2017, and available for fee-for-service (FFS) Medicaid prior authorization that day. Authorization will be approved on a monthly basis. Criteria are based on the American Academy of Pediatrics (AAP) guidance published July 28, 2014.
Medical directors of Medicaid managed care organizations are allowed to end the RSV season for their health plan, by service area, if they demonstrate to HHSC that the local virology has dropped below 10% positivity for two consecutive weeks.
The option to purchase and bill through the Texas Medicaid & Healthcare Partnership (TMHP) is not available for the 2017 season.