While many health plans cover Synagis, the levels of coverage and the requirements for getting it can vary.
Make sure your doctor's office has a copy of your health insurance card and your prescription card, if you have one.
If you are on Medicaid, make sure that your doctor's office is aware.
Use this checklist to help you iron out any potential problems.
Ask your doctor's office to check with the insurance company to see if a prior authorization for Synagis is
needed. If a doctor orders a drug without one, there may be delays in your child's access to care.
Call RSV Connection at 1-877-RSV-9010 for assistance with any of these issues.
Q. Is all of your health plan information correct and up to date?
A. Many employee plans are open to changes during October and November. But if your insurance plan changes at any time, let your doctor's office know immediately. If you're enrolled in a state Medicaid program, you need to let your doctor know before making any changes.
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Q. Have you reviewed all of your health plan benefits carefully?
A. Ask your employer (if appropriate) and your insurance company if Synagis is covered and how they determine if a baby is eligible for Synagis. Share this information with your doctor.
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Q. Did you double check all of your claims or reimbursement forms?
A. Missing or incorrect information on insurance forms can lead to delayed processing and denials. Also make sure that your doctor has all of your baby's latest medical information.
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Q. Does your doctor have backup information to support your baby's case?
A. If there's a chance your baby might be denied coverage, your doctor can provide information on RSV and RSV risk factors, or a letter of medical necessity—if appropriate—to help support your case.
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- 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.
To qualify for assistance, you must apply. Your health care
provider can help you, but the guidelines are simple:
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The patient must live and be treated in the United States
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The patient must not have any health insurance (although you may be in the process of applying for it)
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The household income of the patient’s family must not exceed 400% of the Federal Poverty Level,
as published by the US Department of Health and Human Services annually. (Currently, 400% of the
FPL for a household of 3 is $73,240.)
- 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.
Important Safety Information
What is Synagis® (palivizumab)?
Synagis is a prescription medication that is used to help prevent a serious lung
disease caused by respiratory syncytial virus (RSV) in infants and children at high
risk for severe lung disease from RSV. Over one million children have been given
Synagis. It is given as a shot, usually in the thigh muscle, each month during the
RSV season. Children who develop an RSV infection while receiving Synagis should
continue the monthly dosing schedule throughout the season.
Who should not receive Synagis?
Synagis should not be used in children who have ever had a severe allergic reaction
to Synagis or its ingredients. Signs and symptoms of a severe allergic reaction could
include: itchy rash; difficulty breathing; difficulty swallowing; swelling of the face;
bluish color of the skin; muscle weakness or floppiness; and/or unresponsiveness. If
your child has any of these signs or symptoms of a severe allergic reaction after
getting Synagis, be sure to tell your child's healthcare provider or get medical help
right away.
What are the side effects with Synagis?
Possible, serious side effects include severe allergic reaction which may occur after
any dose of Synagis. Unusual bruising and/or groups of tiny red spots on the skin
have also been reported.
Common side effects of Synagis include fever, cold-like symptoms (upper respiratory
tract infection), including runny nose and ear infection, and rash. Other possible side
effects include skin reactions around the area where the shot was given (like
redness, swelling, warmth or discomfort). In children born with certain heart
problems, other possible side effects include bluish color of the skin and abnormal
heart rhythms.
These are not all the possible side effects of Synagis. Tell your child's healthcare
provider about any side effect that bothers your child or that does not go away.
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