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December 2016 Texas Medicaid Provider Procedures Manual

Appendix B: Vendor Drug Program : B.3 Palivizumab (Synagis) Available Through the VDP

Palivizumab is available to physicians for administering to Medicaid clients only through the VDP. This option enables physicians to have palivizumab shipped directly to their office from a network pharmacy. Physicians will not need to purchase the drug. Physicians who obtain palivizumab through the VDP may not submit claims to Medicaid (TMHP) for the drug.
The administering provider may submit a claim to TMHP for an injection administration fee and any medically necessary office-based evaluation and management service provided at time of injection.
For more information, including the current season’s schedule and a list of participating pharmacies, refer to the HHSC Vendor Drug Synagis Program page at

Texas Medicaid & Healthcare Partnership
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