MedicaidPrior AuthMedium impact
Prior Approval Requests for Synagis
Illinois Medicaid - HFS·IL · Pediatrics, Pulmonology, Infectious Disease·Provider Notice
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
Due to increased RSV prevalence, providers can now submit prior approval requests for Synagis (palivizumab) for Medicaid patients starting October 1, 2023. This is a temporary deviation from usual guidelines, with approvals valid through February 29, 2024.
Action Required
By October 1, 2023: Billing team must implement prior authorization workflow for Synagis (palivizumab) for Medicaid patients. For fee-for-service Medicaid, complete Drug Authorization Request Form and fax to Pharmacy Unit at 217-524-7264. For managed care plans, contact the appropriate plan for approval guidance. Ensure patients meet Department's Synagis Prior Approval Criteria before requesting authorization.