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As the Respiratory Syncytial Virus (RSV) season approaches, we are providing a review of our prior authorization procedure for Synagis. Criteria has been updated this year based on the changes made in the 2009 American Academy of Pediatrics Red Book guidelines.
Select Health, in conjunction with its pharmacy benefit administrator PerformRx, will approve the administration of Synagis® from November 1, 2009, to March 31, 2010, for First Choice and First Choice Kids members who meet the prior authorization requirements. Doses will be limited to a maximum of either 3 or 5 doses depending on gestational age, chronological age, and clinical condition. For a copy of our criteria, please visit the Pharmacy section of our website.
Please contact PerformRx at 866.610.2773 for a copy of the prior authorization form. A representative will fax the form to you and is also available if you need assistance completing the form. If you choose to administer Synagis® in your office this year, we can ship the drug via our preferred vendor, CarePlus Specialty Pharmacy (formerly PharmaCare Specialty Pharmacy). CarePlus can be reached at 800.619.2531. Select Health will reimburse your office for the nurse visit and drug administration. Please use CPT codes 99211 and 90772.
If you have any questions about Synagis® administration, please contact PerformRx at 866.610.2773.
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