MedicaidPrior AuthMedium impact
Respiratory Syncytial Virus (RSV) Prophylaxis with Synagis® (palivizumab)
Nevada Medicaid·NV · Pediatrics, Family Medicine, Pulmonology·Provider Announcement
Effective date
Oct 21, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid's RSV prophylaxis season opens November 1, 2024 through March 31, 2025. Prior authorization requests for Synagis® can be submitted starting October 21, 2024, but claims can only be submitted and reimbursed during the coverage season. Patients who received Beyfortus® cannot receive Synagis® in the same RSV season.
Action Required
By October 21, 2024: Billing team can begin submitting prior authorization requests for Synagis® using form FA-65 on Prime Therapeutics portal. Starting November 1, 2024: Submit approved Synagis® claims only during coverage season (Nov 1 - Mar 31). Verify patients have not received Beyfortus® before authorizing Synagis® for same RSV season. Outside coverage season, include clinical justification and community RSV rates with PA requests.