The Texas Health and Human Services Commission (HHSC) will reopen the Respiratory Syncytial Virus season for select regions in Texas because of reports of a resurgence in the state.
Providers may start monthly palivizumab (Synagis) prophylaxis treatment for all eligible clients beginning as early as June 21, 2021, in the following regions:
- Region 3 — Dallas/Fort Worth
- Region 6 — Gulf Coast
- Region 11 — Lower South Texas
Prior authorization will follow the usual process:
- For clients who have previously met prior authorization approval criteria and have received prophylaxis injections during the season, pharmacies will contact providers to obtain required information for subsequent doses.
- For clients who have not received any injections during the season, providers must obtain prior authorization for the following programs:
- Medicaid managed care (MCO) and the Children’s Health Insurance Plan (CHIP) — Providers must contact the member’s MCO for prior authorization forms and instructions. MCO 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.
- Traditional Medicaid (fee-for-service) — Providers must request prior authorization using the Standard Prior Authorization Request (TDI Form NOFR002) and Synagis Standard Prior Authorization Addendum (HHS Form 1321). Submit completed forms to the dispensing pharmacy. Pharmacy staff will fax the forms to the Texas Prior Authorization Call Center for processing. In addition, providers can call the Texas Prior Authorization Center at 1-877-728-3927 for questions or assistance with the forms.
- Children with Special Health Care Needs (CSHCN) Services Program — Providers must request prior authorization using the Standard Prior Authorization Request (TDI Form NOFR002) and the Synagis Standard Prior Authorization Addendum (HHS Form 1325). Contact the CSHCN Services Program at 1-800-252-8023 for questions or assistance with the form.
HHSC will continue to monitor the resurgence and announce any other seasonal changes.
Contact email@example.com with comments or questions.instructions: