Beginning October 1, 2021, completion of a new prior authorization form for treatment with Synagis (palivizumab) will be required for all children. The Texas Department of State Health Services (DSHS) monitors respiratory syncytial virus (RSV) activity year-round in its 11 Public Health regions and reports data on its website. This data is followed by the Texas Health and Human Services Commission (HHSC) and the RSV Task Force of practicing physicians from around the state. As a result of the recent summertime resurgence in RSV activity, HHSC began opening DSHS regions gradually from June 21 through July 23, 2021. With the traditional 2021-22 RSV season approaching, all Texas DSHS regions will remain open, and all children who meet prior authorization criteria will be eligible for up to 5 monthly doses of Synagis (palivizumab).
On August 10, 2021, The American Academy of Pediatrics (AAP) issued interim guidance regarding the recent, unusual pattern of RSV activity observed across the United States. It supported reassessing the need for Synagis (palivizumab) for eligible children in regions with RSV activity as the fall-winter season approaches. Additionally, the AAP guidance highlights the importance of maintaining a flexible approach to the unique and evolving nature of the current RSV situation.
During Texas's unusual summer RSV season, children who met age and clinical criteria have received monthly summertime doses of Synagis (palivizumab). Children who received doses of Synagis (palivizumab) during the summer RSV season will require reassessment as of October 1, 2021. Children who may require additional doses of Synagis (palivizumab) due to age and clinical condition will require completion of a new prior authorization process for possible additional doses.
Important: The traditional 2021-22 RSV season is considered a new season beginning October 1, 2021, separate from the unusual summer season. Providers must work with the individual MCOs for approval for children with RSV infection risks not identified on Medicaid Form 1321 Synagis Standard Prior Authorization Addendum (Medicaid) or CSHCN Form 1325, Synagis Prior Authorization Addendum (CSHCN). The reconsideration process may require additional supporting documents, such as pertinent diagnostic laboratory tests or medical records.
At this time, 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. The RSV Season Schedule is available for reference on the Vendor Drug Program website. As new developments arise, it may be necessary to close certain regions based on the latest RSV activity reports. HHSC will continue to monitor RSV activity and engage with DSHS and physicians to provide further guidance as the RSV season progresses.
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