- Human Respiratory Syncytial Virus (RSV) causes respiratory tract infections and serious lung disease in infants and children. Synagis (palivizumab) is available for children with high risk to infection.
- The start and end of RSV season is based on the child's county of residence. RSV appears earlier in some counties and remains active later in other counties. HHSC uses RSV statistics from prior years plus regular virology reports to determine the season's start and end dates for each region. HHSC reserves the right to extend or end the season after subsequent review of RSV levels in each region.
- Synagis will be active on both the Medicaid and Children with Special Health Care Needs Services Program formularies beginning Sept. 17, 2018. It will be available for prior authorization that day. Authorization will be approved on a monthly basis. Criteria are based on the American Academy of Pediatrics guidance.
- 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 and Healthcare Partnership is not available.
- Any specialty pharmacy enrolled with HHSC may provide Synagis (palivizumab). A pharmacy must be enrolled with the CSHCN Services Program in order to provide services to children for that program.