MedicaidPrior AuthMedium impact
Prior Approval Requests for Synagis
Illinois Medicaid - HFS·IL · Pediatrics, Pulmonology, Infectious Disease·Provider Notice
Effective date
Aug 5, 2021
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 effective immediately. For fee-for-service Medicaid, complete the Drug Authorization Request Form and fax to 217-524-7264; for managed care plans, contact the plan directly.
Action Required
Immediately: For Medicaid patients needing Synagis, complete Drug Authorization Request Form for fee-for-service patients and fax to 217-524-7264. For managed care Medicaid plans, contact the specific plan for approval guidance. Approvals are valid through August 31st only.