(614)355-5560
South Central / Southeast Region
October 6, 2022
RSV Season – Medicaid Plans Now Covering Palivizumab (Synagis®) for Qualifying Patients

Respiratory syncytial virus (RSV) season in Ohio typically begins in October and ends in March. As a result of factors related to the COVID-19 pandemic, the RSV season shifted in 2021, with high community spread beginning in June and persisting through November. This year, Nationwide Children’s Hospital has identified the start of RSV season on September 17th, due to local positivity rates reaching 10% or greater for two consecutive weeks, indicating high levels of local community transmission of RSV. Palivizumab (Synagis®) is an intramuscular-delivered monoclonal antibody approved as RSV prophylaxis for infants who are high risk for severe RSV infection. Typically, infants born with prematurity (<29 weeks gestational age), congenital heart and/or lung disease, or severe immunosuppression may quality for RSV prophylaxis (AAP Palivizumab Guidance). In order to be effective, palivizumab should be administered each month when RSV rates are highest in the community. The typical months that Ohio Medicaid plans will cover palivizumab is from November through March. Since RSV rates have climbed earlier than usual, Ohio Department of Medicaid had expanded palivizumab coverage to start as of August 25th 2022 for patients that meet the defined clinical criteria for RSV prophylaxis.

Below are resources to assist with identifying patients eligible for palivizumab as well as how you can refer these patients to NCH Homecare for palivizumab administration.  Do not hesitate to reach out to the PFK Pharmacy team (PFKpharmacy@nationwidechildrens.org), if you have questions regarding referrals, prior authorizations, or assessing clinical criteria for potential palivizumab candidates.

NCH Resources:

For Providers: https://www.nationwidechildrens.org/specialties/homecare/for-professionals

General Public: https://www.nationwidechildrens.org/specialties/homecare/synagis-program

 

 

 

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