Synagis®: Insurance coverage | Support information and helpful tips

You want to do everything you can to help protect your baby from RSV. That's why it's important to confirm that Synagis® is covered by your insurance plan and try to iron out any potential problems ahead of time.

While many health plans cover Synagis, the levels of coverage and the requirements for getting it can vary. Here are a few steps you can take to help make sure you're covered:

Review all of your health plan benefits carefully. If appropriate, discuss your benefits with your employer.
Ask your employer and your insurance company if Synagis will be covered and how they determine if a baby is eligible for Synagis. Share this information with your doctor.
Incomplete insurance forms can lead to delayed processing and denials. Make sure that your doctor has all of your baby's medical information. Double check any claims or reimbursement forms to see if anything is missing or incorrect before sending them.
If there's a chance your baby might be denied coverage, ask your doctor to provide backup information. Studies on RSV, risk factors, or a letter of medical necessity—if appropriate—may help support your case.
If your insurance plan changes at any time, let your doctor's office know immediately. Many employers offer open enrollment during October and November so employees can make changes to their health plans. If you're enrolled in a state Medicaid program, you also need to let your doctor know before making any changes.

Synagis Reimbursement Hotline (1-877-480-8082)
For doctors, office staff, and patients who need assistance with patient benefit verifications, distributor triage, preauthorization assistance, denied claims and appeals.
MedImmune Assistance Program (1-877-480-8082)
For eligible patients who do not have health insurance (including Medicaid and Medicare) and are unable to get coverage for Synagis.
Patient Access Network Foundation (1-866-316-7263)
For patients with high co-pays and deductibles, this nonprofit organization may be able to provide support.

The appeals process

If your insurance plan denies coverage or reimbursement for Synagis, you may be able to appeal the decision. Working together with your insurance company and your doctor is the best plan of action. Your doctor's office may contact the reimbursement hotline to discuss the appeals process.

Alison's story
"The doctors in the NICU weren't sure if my insurance would cover Synagis for Christopher. But I knew that RSV was serious enough to ask my pediatrician about it..."

Important Safety Information

Synagis® (palivizumab) is indicated for the prevention of serious lung infections caused by respiratory syncytial virus (RSV) in children at high risk of RSV disease. Synagis is given as a shot, usually in the thigh muscle, each month during the RSV season. The first dose of Synagis should be given before RSV season begins. Children who develop an RSV infection while receiving Synagis should continue the monthly dosing schedule throughout the season. Synagis has been used in more than one million children in the U.S. since its introduction in 1998.

Very rare cases (<1 per 100,000 patients) of severe allergic reactions such as anaphylaxis and rare (<1 per 1,000 patients) hypersensitivity reactions have been reported with Synagis. These rare reactions may occur when any dose of Synagis is given, not just the first one. Also, rare but serious side effects can occur, which may lead to unusual bruising and/or groups of pinpoint red spots found on the skin.

Other side effects with Synagis may include upper respiratory tract infection, ear infection, fever, and runny nose. In children born with heart problems, Synagis was associated with reports of low blood oxygen levels and abnormal heart rhythms. Synagis should not be used in patients with a history of a severe prior reaction to Synagis or its components. Side effects, such as, skin reactions around the area where the shot was given (like redness, swelling, warmth, or discomfort) can also occur.