With respiratory syncytial virus (RSV) season nearly 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 be using the same prior authorization and distribution process for Synagis (palivizumab) during the 2013–2014 RSV season as we did last season.
Synagis requires prior authorization and should be reserved for children with a history of pre-term birth, chronic lung disease, or congenital heart disease. Typically, the first dose is administered at the beginning of November and the last dose at the beginning of March, in order to provide protection through April.
Clinicians may order Synagis for their Harvard Pilgrim patients by faxing the Synagis Medication Request Form to ICORE Healthcare at (866) 554-2673. If the prior authorization criteria are met, ICORE will ship approval orders directly to clinicians’ offices and will bill Harvard Pilgrim. For updated information, please see the Pharmacy Program page, or call Clinical Pharmacy Services at