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Synagis benefits and coverage for 2019-20 season
August 28, 2019

We offer medical or pharmacy benefit coverage options to our members who require respiratory syncytial virus (RSV) immunoprophylaxis and who meet requirements outlined in pharmacy medical policy 422, RSV Immunoprophylaxis.

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Pharmacy benefit coverage

For members who have our pharmacy benefits, we have contracted with four of our retail specialty pharmacies to offer the medication. Prior authorization is required for commercial and indemnity members.  

You can request prior authorization using the Standard Pharmacy Authorization eForm for Synagis.

You can request prior authorization using the Standard Pharmacy Authorization eForm for Synagis.

Get the medication from an in-network retail specialty pharmacy
Please contact one of the specialty pharmacies listed below to obtain Synagis for your patients who require RSV immunoprophylaxis.

Specialty pharmacy Contact
AcariaHealth 1-844-796-2447
Accredo Health Group 1-877-482-5927, Option 3
BriovaRx (OptumRx Specialty Services) 1-844-284-9462
CVS Specialty
(Also a home infusion therapy provider; see medical benefit coverage section below)
1-800-237-2767
Medical benefit coverage

If the member does not have pharmacy benefit coverage through Blue Cross Blue Shield of Massachusetts and meets pharmacy medical policy requirements, coverage is available through the member’s medical benefits.

CVS Caremark, a home infusion therapy provider in our network, can also provide Synagis to our members using their home infusion therapy benefit.

Questions

Call Clinical Pharmacy Operations at 1-800-366-7778.

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