The respiratory syncytial virus (RSV) season began Oct. 1 for many regions of the state and Nov. 1 for counties in the northern and western part of the state. The Texas Medicaid/Children's Health Insurance Program Drug Vendor Program says it will accept RSV medication prior authorization requests by fax.
The start of the RSV season varies based on a Medicaid client's county of residence. Prior authorization forms and the season schedules are available on the Drug Vendor Program website. Prior authorization effective dates for palivizumab (Synagis®) will be based on the patient's county of residence at the start of the season. The Drug Vendor Program notes the option for physicians to purchase and bill through Texas Medicaid and Healthcare Partnership is not available for the 2015-16 RSV season.
- Under fee-for-service Medicaid, physicians must obtain palivizumab (Synagis) through the Vendor Drug Program for all eligible patients. They could begin using the "Fee-for-Service Medicaid Synagis Prior Authorization Request Form" on Sept. 25. To obtain prior authorization, the prescribing physician must complete the form and send it to the dispensing pharmacy. Pharmacy staff will then fax the form to the Texas Prior Authorization Call Center for processing. Physicians can call the Texas Prior Authorization Center at (877) 728-3927 for questions related to submitting forms
- For Medicaid managed care, physicians should contact the patient's plan for forms and instructions by referring to the MCO Prescriber Resources.
- Under the Children with Special Health Care Needs (CSHCN) Services Program, physicians must obtain palivizumab (Synagis) through the CSHCN Services Program for all eligible patients and use the CSHCN Services Program "Synagis Prior Authorization Request Form." Physicians can call the CSHCN Services Program at (800) 252-8023 for questions related to submitting forms.
Action, Nov. 2, 2015
Last Updated On
October 29, 2015