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2024–25 RSV Season and Synagis Prior Authorization Begins for State Health Service Regions

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The Texas Health and Human Services Commission (HHSC) has opened the Human Respiratory Syncytial Virus (RSV) season due to recent trends of positive tests for RSV in all regions. Synagis (palivizumab) is available for children with a high risk of infection. Providers must obtain prior authorization for Synagis.

The following dates are applicable for the RSV season starting and ending in the regions listed below:

Start DateEnd DateRegion
October 1, 2024February 28, 20255, 6
October 15, 2024March 14, 20257, 11
November 1, 2024March 31, 20253, 4, 8
November 15, 2024April 14, 20251, 2, 9, 10

Prior Authorization Requests

Prescribing traditional Medicaid providers in certain regions can begin submitting their prior authorization requests for Synagis on the following dates:

Prior Authorization Fax DateRegion
September 23, 20245, 6
October 1, 20247, 11
October 15, 20243, 4, 8
October 29, 20241, 2, 9, 10

Note: The option to purchase and bill through the Texas Medicaid & Healthcare Partnership (TMHP) is unavailable this season.

Prescribing providers can request Synagis for an infant from participating pharmacies through the Vendor Drug Program using the Medicaid Palivizumab (Synagis) Prior Authorization Request (HHS Form 1321).

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.

Medicaid Managed Care Organizations (MCOs) and the Children's Health Insurance Program (CHIP)

Prescribing providers should use the MCO Search to find contact information for the patient's MCO and learn about the MCO's prior authorization forms and instructions.

CSHCN Services Program

Providers can obtain Synagis through the Children with Special Health Care Needs (CSHCN) Services Program and should use the CSHCN Palivizumab (Synagis) Prior Authorization Request (HHS Form 1325). For questions or assistance with the form, call the CSHCN Services Program at 800-252-8023.

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