UnitedHealthcare responded to a request from TMA and the Texas Pediatric Society (TPS) and changed its policy for covering administration of Synagis to patients at increased risk for complications of respiratory syncytial virus (RSV). United began covering up to five doses, spaced one month apart, in mid-October.
Previously, United paid for the drug from the beginning of the national RSV season starting Nov. 1. However, TPS says its data show the season starts earlier in Texas, primarily because of the state's warmer climate and its size. For example, TPS says RSV onset in West Texas is much later than in Central Texas.
Because of the policy change, United says, it will reimburse physicians if they administered Synagis in October from their own supply of the vaccine. Physicians whose claims for payment were denied can appeal through the usual United appeals process. All subsequent Synagis doses must be obtained through the company's Specialty Pharmacy Program, United says.
To review the new policy, log on to the Medical Policies page of the United Web site and scroll down to Synagis.
Action , Nov. 3, 2008
Last Updated On
July 06, 2010
Originally Published On
March 23, 2010