The upcoming respiratory syncytial virus (RSV) season runs from November 1, 2020, through March 31, 2021. RSV is the most common cause of bronchiolitis and pneumonia among children younger than one year. PerformSpecialty® will be facilitating delivery of the RSV drug Synagis (palivizumab) through the AmeriHealth Direct Ship Drug Program.
Synagis is a humanized monoclonal antibody that provides passive immunity against RSV. It is intended to decrease the morbidity and mortality associated with RSV lower respiratory tract disease in high-risk infants and children. It is not effective in the treatment of RSV disease, and it is not approved for this indication.
It is mandatory for all participating providers to order Synagis for AmeriHealth members through our Direct Ship Drug Program. The 2020-2021 Synagis order forms are now available on our Direct Ship Drug Program website. Please use these versions, as forms from previous Synagis seasons will not be accepted.
How to order Synagis for office use
The following guidelines apply when ordering Synagis:
- Providers should go to the Direct Ship Drug Program webpage for AmeriHealth New Jersey or AmeriHealth Pennsylvania to access the order forms. The order forms are under the Specific Drug Request form section. There are two Synagis order form options:
- Print form: Office staff are required to write the patient and provider information on the form.
- Fillable form: Office staff can type information directly onto the form.
Important: There is no online submission option for these forms; they must be printed and faxed to the number on the form.
- The form must include sufficient clinical information to meet our Synagis coverage criteria, which are based on current American Academy of Pediatrics (AAP) recommendations.
- Fax the completed form (print or fillable) to 1-855-851-4056. Be sure to include any necessary documentation to support the request. Incomplete forms may result in ordering delays.
- Since AmeriHealth pays PerformSpecialty directly for the drug, providers neither pay for doses ordered through PerformSpecialty nor receive reimbursement for the actual pharmaceutical. Providers can still receive payment for the administration of the drug.
- Synagis will generally be approved for office administration only, unless a patient is receiving home nursing services for a separate indication.
- Upon approval of the request, Synagis will be shipped to the provider’s office monthly during the RSV season. Shipping for the 2020-2021 RSV season begins on Monday, November 2, 2020, and continues through Wednesday, March 31, 2021. Up to five doses (one dose every 30 days) will be shipped per member.
AmeriHealth provides coverage under the medical benefit for the administration of Synagis for infants and children during the RSV season, in accordance with the current recommendations from the AAP. These recommendations are subject to change.
The complete list of coverage criteria for Synagis can be found in the AmeriHealth Medical Policy #08.00.22m: Immune Prophylaxis for Respiratory Syncytial Virus (RSV). To view this policy, visit our Medical and Claim Payment Policy Portal.
If you have questions about Synagis, please call Customer Service at 1-888-YOUR-AH1 (1-888-968-7241) for AmeriHealth New Jersey or at 1-800-275-2583 for AmeriHealth Pennsylvania.