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2021-22 Respiratory Syncytial Virus Assessment and Synagis Authorization

Last updated on 9/9/2021

The recent summer resurgence in respiratory syncytial virus (RSV) activities in Texas resulted in the Texas Health and Human Service Commission’s (HHSC) decision to gradually open all Texas Department of State Health Services (DSHS) regions, allowing all members who meet prior authorization criteria to receive monthly doses of Synagis (palivizumab). To address concerns about the appropriateness of giving additional doses or starting new therapy during the fall and winter seasons, providers will be required to re-assess the need for prophylaxis therapy for the children in their regions. A new prior authorization for all children is required beginning October 1, 2021.

It is not possible to anticipate whether RSV activity will continue to spread equally in all regions or whether it will increase to levels of activity typically seen during the fall and winter months. As new developments arise, it may be necessary to close certain regions based on the latest RSV activity reports. Each region's fall and winter season schedule is available for reference on the Vendor Drug Program website. HHSC will continue to monitor atypical RSV activity and provide further guidance as the traditional 2021-22 RSV season progresses. 

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

Prior Authorization Requests for Medicaid and CHIP Managed Care Organizations

Providers must contact the member's 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.

Prior Authorization Request for Traditional Medicaid

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

Providers must send both completed forms 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. Approval for patients with RSV infection risks not identified on the form may require additional supporting documents, such as pertinent diagnostic laboratory tests or medical records. Allow up to two weeks for prior authorization processing and shipping.

Prior Authorization Request for the Children with Special Health Care Needs Services (CSHCN) Program

Providers must 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 forms. Prior authorization approval for patients with RSV infection risks not identified on the CSHCN Synagis Prior Authorization form may require additional supporting documents, such as pertinent diagnostic lab tests, or medical records. Allow up to two weeks for prior authorization processing and shipping.