MedicaidPrior AuthMedium impact
BT202252: IHCP authorizes palivizumab RSV prophylaxis for high-risk IHCP members
Indiana Medicaid (IHCP)·IN · Pediatrics, Pulmonology, Neonatology·Provider Bulletin
Effective date
Jul 7, 2022
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP/Medicaid) now authorizes palivizumab (Synagis) RSV prophylaxis for high-risk members outside the normal RSV season (Nov 1 - Mar 31) due to increased RSV activity. Prior authorization is required for all qualifying IHCP members starting July 7, 2022.
Action Required
Immediately: Billing team must verify prior authorization requirements for palivizumab (Synagis) administration for Indiana Medicaid members. For fee-for-service members, obtain PA using Synagis PA Form from OptumRx website. For managed care members (HIP, Hoosier Care Connect, Hoosier Healthwise), contact the member's MCE for PA requirements. Update billing workflows to check PA status before administering Synagis outside traditional RSV season.