MedicaidPrior AuthMedium impact
Coverage for Synagis Extended through March 31, 2024
Illinois Medicaid - HFS·IL · Pediatrics, Pulmonology, Infectious Disease·Provider Notice
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Illinois Medicaid is extending coverage for Synagis (palivizumab) through March 31, 2024 due to continued RSV prevalence. Due to a Change Healthcare security breach affecting the prior approval system, providers can submit Synagis claims without prior authorization until the system is restored.
Action Required
Through March 31, 2024: Providers billing Synagis (palivizumab) for Illinois Medicaid patients can submit 837 Professional claims without prior authorization due to system outage. Contact appropriate managed care plans for approval guidance. Pharmacies should continue dispensing medication - HFS will resolve claims once system is operational.