Medicaid Coverage for RSV Treatment Has Ended for This Season

Friday, April 14, marked the end of the 2016–17 respiratory syncytial virus (RSV) season for all counties in Texas, the Texas Health and Human Services Commission (HHSC) announced. HHSC issued no extensions for any parts of the state this season based on recommendations from the Texas Pediatric Society RSV Task Force.

Coverage of Synagis (palivizumab) for RSV ended April 14 for people enrolled in Medicaid (both traditional and managed care) and the Children with Special Health Care Needs (CSHCN) Services program. Pharmacy claims and prior authorization requests are no longer being accepted or reviewed.

The start and end of the RSV season in Texas each year is based on an individual's county of residence. RSV appears earlier in some counties and remains active later in other counties. HHSC uses RSV statistics from prior years plus regular virology reports to determine the season's start and end dates for each region.

RSV causes respiratory tract infections and serious lung disease in infants and children. During the season, Synagis (palivizumab) is available with prior authorization for treating high-risk patients enrolled in Medicaid or in the CSHCN Services program.

Action, April 17, 2017

Last Updated On

April 17, 2017

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