2018-2019 Synagis Season Schedule
Date: 09/20/18
Superior HealthPlan will follow the Texas Vendor Drug Program (VDP) Syangis® Prior Authorization Guidelines for the 2018-2019 Respiratory Syncytial Virus (RSV) season. VDP guidelines for clinical edits are found on the VDP website.
The 2018-2019 season will follow a four-part roll-out schedule on October 1, October 15, November 1 and November 15, 2018. Providers are strongly encouraged to follow the schedule closely when submitting prior authorization requests. The start dates are region/county specific. Please refer to the VDP’s RSV Season Schedule for your county’s exact region, start date and season end date.
Helpful Synagis prior authorization information:
- Please include any previous NICU doses with the prior authorization submission.
- Once authorized, a member who has had RSV this season should not continue to receive refills of Syangis®.
- The specialty pharmacy will need a prescription sent to the pharmacy directly by the medical office for any member with approved prior authorization.
Synagis® is available through a limited distribution network as established by the manufacturer. AcariaHealth and CVS/Caremark are the two specialty pharmacy providers contracted with Superior for Synagis®. Please select your preference for specialty pharmacy (AcariaHealth or CVS/Caremark) on the following prior authorization form:
Please note: Providers may also use/submit the Texas Department of Insurance (TDI) Texas Standard (Medicaid) Prior Authorization Request Addendum (PDF).
The specialty pharmacy will be responsible for the delivery of the injectable product and the overall coordination of the drug distribution process. All injectable products will be billed directly to Superior by the specialty pharmacy and shipped to the provider’s office. Administration charges for the injection should be billed directly to Superior on a (HCFA) CMS 1500 claim form, using CPT code 96372. Providers can also bill for an appropriate office visit for each administration of the drug.
Please note: Automated refills are not permissible per the Texas Medicaid Provider Procedures Manual. Providers will need to request or authorize the refill from the pharmacy each time it is needed. If the member has had RSV this season the office should not continue to request refills of Synagis for that member.
Superior’s Pharmacy department will perform all prior authorizations for Synagis®. To submit your request, fax the completed authorization form (linked above) to 1-866-683-5631. Once approved the medical office should submit a prescription to the specialty pharmacy directly.
For questions, please contact Superior’s Pharmacy department at 1-800-218-7453, ext. 22080.