Based on statistics from previous respiratory syncytial virus (RSV) seasons, most Texas counties will start the season Oct. 1, 2011, and end Feb. 28, 2012. Counties in the western part of the state will start Nov. 1, 2011, and end March 31, 2012. Synagis® is used to help prevent a serious lung disease caused by RSV in infants and children at high risk for the disease.
Prior approvals for Synagis® are available now through the Medicaid Vendor Drug Program. Learn more about the Vendor Drug Synagis process and get the county schedule on the Texas Medicaid/CHIP Vendor Drug Program website.
Blue Cross and Blue Shield of Texas (BCBSTX)
Complete the BCBSTX Synagis Request Form for predetermination (find it under Medical Policy Forms). Online and hard-copy forms are available. Fax the latter to Allan J. Chernov, MD, (Medical Director, Health Care Quality & Policy) at (972) 766-5559.
To order the drug, fax the Synagis Request Form, along with written authorization from BCBSTX, to Triessent at (866) 203-6010. An approved predetermination will cover a maximum of five monthly injections for that patient for the full 2011-12 RSV season (Oct. 1 to March 15). No additional reviews will be needed.
For out-of-state BCBSTX members, contact the member’s home plan (see the back of the member’s ID card) for eligibility and benefit information.
Under UnitedHealthcare, you must obtain Synagis® from UNC’s contracted specialty pharmacy vendor for Synagis, Prescription Solutions. This is a change from the previous year, as CVS Caremark is no longer a contracted specialty pharmacy provider for Synagis.
Prescription Solutions staff follows UnitedHealthcare’s drug policy criteria for Synagis and works directly with UNC in determining whether Synagis treatment is covered. Use the UNC enrollment form for RSV, found on the UNC Pharmacy Resources page, to obtain Synagis. If you have questions about obtaining Synagis, call the UNC Specialty Pharmacy Referral Line at (866) 429-8177. See the UNC September 2011 Network Bulletin Supplement (PDF) for more information.
Revised Oct. 3, 2011
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