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Update: Additional Synagis Doses Allowed for Members for the 2021–2022 Respiratory Syncytial Virus Season

Effective immediately, ForwardHealth will approve additional doses of Synagis for certain BadgerCare Plus and Medicaid members that currently have an approved prior authorization (PA) request for dates of service (DOS) in September and October of 2021 for the 2021–2022 respiratory syncytial virus (RSV) season. In addition, ForwardHealth will approve additional doses of Synagis for members that have a previously amended PA request, where the initial PA request was for DOS in July and August of 2021. The approval for additional Synagis doses remains temporary policy and is only applicable for the 2021–2022 RSV season.

For members who have an approved PA request for Synagis for DOS beginning:

  • September 1, 2021, through September 30, 2021, the PA request may be amended to allow for seven doses.
  • October 1, 2021, through October 31, 2021, the PA request may be amended to allow for six doses.

For members who have an amended PA request for additional doses of Synagis, where the initial PA request was for DOS beginning:

  • July 28, 2021, through July 31, 2021, the PA request may be amended again to allow for nine total doses.
  • August 1, 2021, through August 31, 2021, the PA request may be amended again to allow for eight total doses.

Any amended PA requests for additional doses of Synagis for the 2021–2022 RSV season will be based solely on the child’s most current weight that ForwardHealth has received from the prescriber or the billing provider (pharmacy provider). ForwardHealth will not consider other requests to amend Synagis PA requests for more than the maximum-allowed five doses.

ForwardHealth is actively reviewing and amending Synagis PA requests for DOS beginning on July 28, 2021, through October 31, 2021, as outlined above. If providers have any questions regarding this temporary policy or the status of any approved or amended Synagis PA requests, they should contact the Drug Authorization and Policy Override Center at 800-947-9627. For more information about current PA policy for Synagis, providers may refer to the Prior Authorization Requests and Amendments for Synagis topic (#7877) in the ForwardHealth Online Handbook.

 
 
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