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2020-21 RSV Season Begins October 1, 2020

Last updated on 8/19/2020

The 2020-21 Respiratory Syncytial Virus (RSV) season begins October 1, 2020, for many counties in Texas. The schedule is staggered and is based on a patient's county of residence at the start of the RSV season. Refer to the Synagis season schedule for each region’s start and end dates.

The Health and Human Services Commision (HHSC) will make the following changes this season to Synagis coverage and prior authorizations: 

  • Vendor Drug Program (VDP) will not end-date National Drug Codes (NDCs) for Synagis as in previous years and the drug will remain active on the formulary. Year-round access to Synagis on the Medicaid Formulary allows for consideration of off-season requests.
  • Access to Synagis for children in the Children’s Health Insurance Program (CHIP) is available as a pharmacy benefit effective September 1, 2020. The Medicaid prior authorization criteria also apply to CHIP. Synagis is not available as a medical benefit for CHIP. 
  • Providers will use the Texas Standard Prior Authorization Request Form for Prescription Drug Benefits and Synagis Prior Authorization Addendum for prior authorization requests. 
  • HHSC will remove the prior authorization criteria for the specialist or sub-specialist prescribing.

Prior Authorization Requests

The following prior authorization requests applies for the following programs:

Traditional Medicaid

Providers obtain Synagis through the Vendor Drug Program and request prior authorization using both forms:

Providers may submit prior authorization requests as early as September 1, 2020. To obtain prior authorization, complete both forms and send them to the dispensing pharmacy. Pharmacy staff will fax the forms to the Texas Prior Authorization Call Center for processing. Providers can call the Texas Prior Authorization Center at 877-728-3927 for questions or assistance with the form.

Managed Care (Medicaid and CHIP)

Contact the patient’s Medicaid managed care organization (MCO) for prior authorization forms and instructions. Contact information is available on the Prescriber MCO Assistance Chart or providers can refer to the MCO Resources for links to each MCO’s clinical prior authorizations.

The Children with Special Health Care Needs (CSHCN) Services Program

Providers obtain Synagis through the CSHCN Services Program and request prior authorization using both forms:

Contact the CSHCN Services Program at 800-252-8023 for questions or assistance with the form.

Contact with comments or any questions on Synagis criteria or prior authorization processes.