September 10, 2009
RE: 2009-2010 RSV (Respiratory Syncytial Virus) Season
Dear PCHP Provider:
Parkland Community Health Plan (PCHP) is in the seventh year of its initiative to combat RSV (respiratory syncytial virus) in at risk children. The guidelines adopted for PCHP members are consistent with those endorsed by the Texas HHSC/VDP.
HHSC has determined that at-risk members may receive doses beginning October 1, 2009. A complete Synagis® series consists of one shot given monthly from October through February for a total of 5 (five) shots to prevent RSV infection. NICU graduates and premature infants should typically be given the first shot before they are discharged from the hospital if it is during the RSV season.
The HHSC has developed a Texas Medicaid Vendor Drug Program Prior Authorization Request and Prescription for listing indications for administration of the Synagis® series. The updated form is enclosed in this mailing.
PCHP has identified the members on the attached listing who are currently assigned to your panel who may be eligible for the Synagis® series. Please review the listing and, based on your knowledge of these members, determine whether or not they are candidates for receiving Synagis®. Letters were mailed to the members at the address provided on the report. The letter encourages the parent or other caregiver to check with the child’s PCP for a recommendation about this prevention measure.
The Synagis® product is being provided by the Texas Vendor Drug Program (VDP) at no charge to qualifying Medicaid members and therefore, must be acquired through the VDP. Providers will be reimbursed for a Synagis® administration fee. If you are not providing these injections in your office, you must complete and sign a copy of the enclosed Texas Medicaid Synagis® (Palivizumab) Prior Authorization/Prescription Request Form and fax to the provider listed below:
Drs. Gelfand/Copenhaver Phone 972-566-6996
Multiple clinic sites FAX 1-866-252-1749
US Bioservices (Medically necessary Phone 1-877-872-4604
Home visits) FAX 1-877-872-4606
Synagis® is not a benefit for CHIP/CHIP Perinate Newborn members through the VDP. However, PCHP will provide reimbursement for these members at current Medicaid rates to providers who wish to participate. Again, you may refer these members to the above provider by using the same form. If you prefer to administer Synagis® within your practice, you may use any VDP approved pharmacy to obtain Synagis®. Your office must file a claim with PCHP for reimbursement of the drug (90378) and the administration fee (96372). Prior authorization is not required unless the member does not meet the approved criteria and you wish to request a review by the PCHP Medical Director. Providers who administer Synagis® to PCHP CHIP/CHIP Perinate Newborn members who do not meet the approved criteria will not be reimbursed for this drug or its administration.
The administering provider will do Prior Authorization through the Vendor Drug Program for Medicaid members. If you have any questions about RSV or the information enclosed, please contact our Provider Relations Department at 888-672-2277 (option 2).
Sincerely,
Barry Lachman, M.D., Medical Director
Parkland Community Health Plan
Enc.
Texas Medicaid Synagis Prior Authorization Form/Prescription Request Form
List of panel members who may meet Synagis administration criteria |
