This article is for all providers that prescribe Synagis for our members
We offer medical or pharmacy benefit coverage options to our members who require respiratory syncytial virus (RSV) immunoprophylaxis and who meet the requirements outlined in pharmacy medical policy 422, RSV Immunoprophylaxis.
At this time, our medical and pharmacy benefit options are for Synagis only.
A new monoclonal antibody product, Beyfortus (Nirsevimab), will be available soon (anticipated to be in time for the 2023-24 RSV season). We expect that Beyfortus will replace Synagis for all indications and that it will be indicated for all infants within a certain age range. Look for more information about this product as we learn more about its availability.
For members who have our pharmacy benefits, we have contracted with three 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 SynagisStandard 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 |
|
CVS Specialty |
1-800-237-2767 |
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.
We’re here to support you. Please call Pharmacy Operations at 1-800-366-7778.
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