We cover Synagis (palivizumab) according to the Respiratory Syncytial Virus (RSV) prophylaxis guidelines the American Academy of Pediatrics (AAP) Committee on Infectious Diseases wrote and published in the 2009 AAP Red Book®. For the upcoming RSV season, coverage will be available October 15, 2010 through March 31, 2011.
If your doctor prescribes Synagis for a child covered under your policy, please have your doctor call the Caremark Prior Authorizations department at 866-814-5506. On behalf of BlueCross BlueShield of South Carolina, Caremark assists in the administration of our prescription drug program. Caremark is an independent company that provides pharmacy benefits management. Your doctor can also fax prior authorization requests to 888-836-0730.
You can submit prior authorization requests before October 15, but coverage is only available October 15 through March 31. Also, the number of Synagis doses that we cover may vary depending on the patient’s gestational age, diagnosis and risk factors.