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 2019-20 respiratory syncytial virus (RSV) season begins Oct. 1. VDP will accept prior authorization requests for Synagis beginning Sept. 9 for people in both traditional Medicaid and the Children with Special Health Care Needs Services Program. Authorization are approved monthly. HHSC uses statistics from prior years plus regular virology reports to determine the season dates for each region. HHSC reserves the right to extend or end the season after subsequent review of RSV levels in each region. Medical directors of Medicaid managed care organizations cay end the RSV season for their MCO, by service area, if they demonstrate local virology has dropped below 10% positivity for two consecutive weeks.
This season’s prior authorization criteria are the same used for last year’s season, based on the American Academy of Pediatrics guidance. 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 in the program.