MedicaidPrior AuthMedium impact
Prior Approval Requests for Synagis Dosing
Illinois Medicaid - HFS·IL · Pediatrics, Pulmonology, Infectious Disease·Provider Notice
Effective date
Oct 1, 2022
We identified it
Jun 20, 2026
Summary
Illinois Medicaid is allowing early prior authorization requests for Synagis (palivizumab) starting October 1, 2022, due to increased RSV incidence. Coverage will run from October 1, 2022 through February 28, 2023 for both fee-for-service and managed care Medicaid patients.
Action Required
By October 1, 2022: For Illinois Medicaid fee-for-service patients needing Synagis, billing team must complete the Drug Authorization Request Form for Synagis and fax to Pharmacy Unit at 217-524-7264. For managed care patients, contact the appropriate managed care plan for approval guidance. Ensure patients meet Department's Synagis Prior Authorization and Rounding Criteria before submitting requests.