Respiratory Syncytial Virus (RSV) Prophylaxis Season Reopening Across All Regions
The TPS RSV Task Force recommended the reopening of all public health regions to monthly administration of RSV prophylaxis. The Task Force also encourages all physicians to monitor local activity. . As RSV activity and the hospitalization of young children increase locally, the Task Force recommends the administration of palivizumab (Synagis). You can refer to the DSHS RSV Surveillance Report to aid in local decision-making. The Task Force uses the guideline of a local positivity rate of more than 5% for RSV PCR testing or more than 10% for RSV antigen testing each for at least two consecutive weeks and increasing clinical RSV activity in children as a reference to begin local RSV prophylaxis. This will ensure local healthcare entities will be able to identify the beginning of their RSV season. The Task Forces asks that members work with their hospital lab directors to submit data to NERVSS weekly and to monitor hospitals for RSV admissions or COVID coinfections. Please contact the RSV Task Force staff, Alix Bronner, if you have questions or updates to share with the Task Force.
Original Posting - Published on May 25, 2022
The Texas Health and Human Services Commission (HHSC) is aware of a summertime RSV resurgence in multiple regions across the state. In response to this RSV activity and consultation with medical experts from across the state, HHSC will take necessary action to prevent the further spread of RSV by reopening all regions to monthly administration of palivizumab (Synagis) prophylaxis to eligible members, starting June 1, 2022. Providers may start monthly palivizumab (Synagis) prophylaxis treatment for all eligible members beginning as early as June 1.
Based on a higher RSV positivity rate in regions 3 and 6, HHSC has encouraged Medicaid managed care organizations (MCOs) to allow access earlier than June 1 if administratively possible. Pharmacies should contact the member’s MCO for further details and instruction.
A new prior authorization request is required for all members who meet the criteria for RSV prophylaxis . Per HHSC policy and RSV guidelines, members should receive one dose per month, up to five doses per treatment course.
MCO medical directors can end the RSV season for their given service area if data is submitted to HHSC to indicate the local polymerase chain reaction test virology has dropped below 3% positivity for two consecutive weeks. At this time, it is not possible to anticipate how this summertime RSV activity will impact the traditional 2022-23 RSV season. HHSC will continue to monitor all regions to provide further guidance as the RSV season progresses.
Forms and contacts
Managed Care (Medicaid, CHIP)
- Contact: MCO Pharmacy Prior Authorization
Traditional Medicaid
CSHCN Services Program
Resources
- Texas DSHS Infectious Disease Control: Respiratory Syncytial Virus
