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 be using the same prior authorization and distribution process for Synagis (palivizumab) during the 2014-2015 RSV season as we did last season.
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 5 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.
Clinicians may order Synagis for their Harvard Pilgrim patients by faxing the Synagis Medication Request Form to ICORE Healthcare at (800) 327-4561. For further details, please refer to our Synagis Medication Request Guideline. If the prior authorization criteria are met, ICORE will ship approved orders directly to clinicians’ offices and will bill Harvard Pilgrim.
For more information, please see the Pharmacy Program page, or call Clinical Pharmacy Services at