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2025–2026 RSV Season Begins for State Health Service Regions

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The Texas Health and Human Services Commission (HHSC) will start the Human Respiratory Syncytial Virus (RSV) season for all state regions.

This season, providers cannot purchase and bill palivizumab (Synagis) through the Texas Medicaid & Healthcare Partnership (TMHP). Providers can only obtain the vaccine by submitting a prior authorization request.

The following dates indicate the start and finish of the RSV season in the regions listed below:

Start DateEnd DateRegion
October 1, 2025February 28, 20265, 6
October 15, 2025March 13, 20267, 11
November 1, 2025March 31, 20263, 4, 8
November 15, 2025April 17, 20261, 2, 9, 10

Prior Authorization Requests

Medicaid Fee-for-Service

Prescribing providers can request palivizumab (Synagis) from participating pharmacies through the Vendor Drug Program (VDP) for the following clients:

  • Infants
  • Children 18 years of age or younger with a high risk of infection

Providers must complete the Medicaid Palivizumab (Synagis) Prior Authorization Request (HHS Form 1321) and fax it to the dispensing pharmacy. The pharmacy will then submit it to the Texas Prior Authorization Call Center for processing.

Prescribing providers in certain regions can begin submitting their prior authorization requests for palivizumab (Synagis) on the following dates:

Starting Submission DateRegion
September 22, 20255, 6
October 1, 20257, 11
October 15, 20253, 4, 8
October 29, 20251, 2, 9, 10

MCOs and CHIP

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

Children's Health Insurance Program (CHIP) providers must submit the Medicaid Palivizumab (Synagis) Prior Authorization Request (HHS Form 1321) to request prior authorization.

The CSHCN Services Program

Providers can obtain palivizumab (Synagis) through the Children with Special Health Care Needs (CSHCN) Services Program and must complete the CSHCN Services Program Palivizumab (Synagis) Standard Prior Authorization Request (HHS Form 1325) and fax it to the dispensing pharmacy. The pharmacy will then submit the form to the CSHCN Services Program by fax to 512-776-7238.

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

Got Questions?

Traditional Medicaid providers should call the Texas Prior Authorization Call Center at 877-728-3927 for assistance when completing HHS Form 1321.

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