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RSV Season and Synagis Prior Authorization Begin for All Health Service Regions

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The Texas Pediatric Society (TPS) respiratory syncytial virus (RSV) task force tracks the most recent trends of positive tests for RSV and has recommended starting the RSV season and accepting Synagis prior authorization requests.

The dates below indicate the start of the RSV season for the state regions:

  • Region 11: October 2, 2023
  • Regions 3, 4, 5, 6, 7, and 8: October 16, 2023
  • Regions 1, 2, 9, and 10: November 1, 2023

Visit the HHSC Vendor Drug Program (VDP) website for details. The schedule is staggered and based on the client’s county of residence at the start of the season.

Prescribing providers in regions where the RSV season has started may begin to administer Synagis to infants who meet the criteria listed on Form 1321, Synagis Standard Prior Authorization Addendum (Medicaid).

Prior Authorization Requests

Traditional Medicaid

Prescribing providers may submit prior authorization requests beginning on the following dates:

  • Region 11: September 25, 2023
  • Regions 3–8: October 9, 2023
  • Regions 1, 2, 9, and 10: October 25, 2023

Prescribing providers can request Synagis for infants from participating pharmacies through the HHSC VDP using Form 1321, Synagis Standard Prior Authorization Addendum (Medicaid).

Providers must complete the form and send it to the dispensing pharmacy. The pharmacy will then submit it to the Texas Prior Authorization Call Center for processing.

For questions or assistance with the form, call the Texas Prior Authorization Call Center at 877-728-3927.

Note: The option to purchase and bill Synagis through the Texas Medicaid & Healthcare Partnership (TMHP) is not available this season.

Medicaid Managed Care (MCO) and the Children’s Health Insurance Program (CHIP)

Prescribing providers must contact the patient's MCO for prior authorization forms and instructions. To find the contact information for each MCO, use the VDP’s MCO Search function.

The CSHCN Services Program

Providers can obtain Synagis through the Children with Special Health Care Needs (CSHCN) Services Program and should use Form 1325, Synagis Prior Authorization Addendum (CSHCN).

Note: For questions or assistance with the form, call the CSHCN Services Program at 800-252-8023.

New Products This Year

The U.S. Food and Drug Administration (FDA) has approved several new products to prevent RSV this year. These products include the following:

  • The monoclonal antibody nirsevimab-alib (Beyfortus), which is manufactured by AstraZeneca/Sanofi, is administered as a single intramuscular dose for the prevention of severe RSV infections in:
  • Newborns and babies who are birth through 8 months of age and are born during or entering their first RSV season.
  • Children who are 9 through 19 months of age and remain at risk of severe RSV disease through their second RSV season.

Note: This medication is available through the Texas Vaccines for Children Program (TVFC).

  • The RSVpreF vaccine Abrysvo, which is manufactured by Pfizer, is indicated as a single dose for the prevention of lower respiratory tract disease (LRTD) caused by RSV in the following groups:
  • People who are 60 years of age or older
  • Infants who are birth through 6 months of age whose mothers were given the vaccine during 32 through 36 weeks of gestational age

Note: This vaccine will be available through the TVFC only for pregnant individuals who are 19 years of age or younger.

  • The RSVPreF3 vaccine Arexvy, which is manufactured by GlaxoSmithKline, is indicated as a single dose in people who are 60 years of age or older.

Note: This vaccine is not available through the TVFC.

Email vdp-formulary@hhsc.state.tx.us with comments or questions.