AmeriHealth will extend coverage for immune prophylaxis with Synagis (palivizumab) to include doses given in 2021 before the start of the 2021-2022 respiratory syncytial virus (RSV) season. This decision is based on the recommendation of the American Academy of Pediatrics (AAP), due to an increased number of RSV cases seen between the end of the 2020-2021 season and the start of the 2021-2022 season.
Patient impact
Your patients who received Synagis during the interseasonal period (April – October 2021) are still eligible to receive the complete five-dose regimen of Synagis for the 2021-2022 RSV season (November 1, 2021 – March 31, 2022). However, providers must obtain authorization from AmeriHealth for this extended coverage.
American Academy of Pediatrics position
The AAP recommendation is based on data from the National Respiratory and Enteric Virus Surveillance System (NREVSS), by identifying the first week of two consecutive weeks that RSV real-time-polymerase chain reaction (RT-PCR) test positivity is three percent or greater, or antigen detection positivity is 10 percent or greater. Increases in RSV cases were reported throughout the spring and summer of 2021, leading to the AAP's recognition of an interseasonal RSV season for 2021.
Resources
More information about the interseasonal administration of Synagis is available here.
The complete list of coverage criteria for Synagis is available in the AmeriHealth Medical Policy #08.00.22o: Immune Prophylaxis for Respiratory Syncytial Virus (RSV). You can view the policy on the Medical and Claim Payment Policy Portal.
The 2021-2022 Synagis order forms are available on the Direct Ship Drug Program web pages:
Questions
If you have questions about Synagis, please call AmeriHealth New Jersey Customer Service at 1-888-YOUR-AH1, AmeriHealth Pennsylvania Customer Service at 1-800-275-2583, or AmeriHealth Administrators Customer Experience at 1-844-352-1706.