With respiratory syncytial virus (RSV) season approaching, Harvard Pilgrim would like to remind providers of our policy regarding Synagis (palivizumab), an injection of antibodies used to protect high-risk infants from severe RSV disease. Harvard Pilgrim will require a prior authorization for Synagis during the 2017-2018 RSV season. Please keep in mind, however, that CVS Specialty is now Harvard Pilgrim’s preferred specialty vendor and will handle dispensing of this medication.
Synagis requires prior authorization and should be reserved for infants with a history of pre-term birth, and children with chronic lung disease or congenital heart disease. For members who qualify to receive five doses, the first dose is typically administered at the beginning of November and the last dose at the beginning of March, in order to provide protection into April.
To order Synagis, clinicians should complete the appropriate form, found on the Pharmacy prior authorization page on Harvard Pilgrim’s website. Massachusetts and New Hampshire providers will also need to fax a copy of the prescription to CVS Specialty at 800-323-2445, since their state-specific standard forms don’t include a prescription section. However, the form for providers in all other states allows for the capability of including prescription information.
For more information, please visit the Pharmacy section of Harvard Pilgrim’s provider website or call Clinical Pharmacy Services at 617-509-1786.