MedicaidPrior AuthMedium impact
Authorization for Palivizumab - 2019-2020 Respiratory Syncytial Virus Season pdf
Connecticut Medicaid (HUSKY Health)·CT · Pediatrics, Pulmonology·Prior Authorization
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY) requires prior authorization for palivizumab (Synagis®) injections for the 2019-2020 RSV season when provided on an outpatient basis. Specific PA forms must be completed and faxed to designated pharmacies or CHNCT depending on the provider type.
Action Required
Immediately: Providers treating HUSKY members requiring palivizumab (Synagis®) must obtain prior authorization before outpatient administration. Complete the appropriate PA form (hospital or pharmacy version) and fax with clinical documentation to CHNCT at (203) 774-0549 for hospitals or to designated preferred pharmacies (CVS/Caremark or Walgreens) for other providers. Claims will be denied without proper prior authorization.