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2013-2014 Season Reminders for Synagis®

September 17, 2013

The Respiratory Syncytial Virus (RSV) season is upon us. We would like to take this opportunity to remind you of some important details regarding Synagis (palivizumab) intramuscular (IM) injections for the prevention of serious lower respiratory tract infection caused by RSV.

  • Coverage for Synagis IM injections is limited to members who meet the BCBSIL Medical Policy criteria. Refer to BCBSOK Medical Policy RX504.009 Respiratory Syncytial Virus (RSV) Immunoprophylaxis, located in the Standards and Requirements/Medical Policy section of our website at bcbsok.com/provider.
  • The Synagis Statement of Medical Necessity Form  is available on our website under the Education and Reference/Forms section.
  • Prime Specialty Pharmacy is both a medical and pharmacy provider for a wide variety of specialty medications, including Synagis. To order Synagis, fax your request along with appropriate documentation to Prime Specialty Pharmacy 877-828-3939.

 

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The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are instructed to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member's certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.

Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC (Prime), a pharmacy benefit management company. Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association, contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. HCSC, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.