The 2022-2023 respiratory syncytial virus (RSV) season runs from November 1, 2022, through March 31, 2023. RSV is the most common cause of bronchiolitis and pneumonia among children younger than one year. Synagis® (palivizumab) helps prevent lung diseases associated with RSV in at-risk infants.
This season, PerformSpecialty® will facilitate delivery of Synagis through the New Jersey AmeriHealth companies, AmeriHealth Insurance Company of New Jersey and AmeriHealth HMO, Inc., (collectively AmeriHealth New Jersey), the Pennsylvania AmeriHealth company, AmeriHealth HMO, Inc. (AmeriHealth Pennsylvania), and AmeriHealth Administrators Direct Ship Drug Programs.
It is mandatory for all participating providers to obtain Synagis through the AmeriHealth Direct Ship Drug Programs for their patients (our members) with AmeriHealth coverage. Shipping for the 2022-2023 RSV season begins on Tuesday, November 1, 2022, and continues through Friday, March 31, 2023. Providers who request Synagis in advance of the RSV season must complete the General Request Form on the AmeriHealth New Jersey, AmeriHealth Pennsylvania, or AmeriHealth Administrators Direct Ship Drug Program webpages.
How to order Synagis for office use
- You can complete the Synagis form in two ways.
- Printed form: Office staff print the form and write out the member and provider information.
- Fillable form: Office staff type the member and provider information directly onto the form and then print it.
- Fax the completed form to 1-855-851-4056. Be sure to include any necessary documentation to support the request. Incomplete forms may result in ordering delays.
- Upon approval of the request, Synagis will be shipped to the provider's office monthly during the RSV season. Up to five doses (one dose every 30 days) will be shipped per member.
Coverage and reimbursement guidance
Synagis is eligible for coverage under the medical benefit for members who meet our coverage criteria. The order form must include sufficient clinical information about the member to meet the criteria, which are based on current recommendations from the American Academy of Pediatrics (AAP) and are subject to change.
The complete list of coverage criteria for Synagis can be found in the AmeriHealth Medical Policy #08.00.22o: Immune Prophylaxis for Respiratory Syncytial Virus (RSV).
Synagis 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.
Since providers do not pay for doses of Synagis ordered through the Direct Ship Drug Program, they cannot receive reimbursement for the drug. However, providers can be reimbursed for the administration of Synagis.
Synagis is only approved for office administration unless a member is receiving home nursing services for a separate indication.
Interseasonal concerns
Some regions of the country may have concerns about interseasonal RSV. AmeriHealth will follow guidance from the Centers for Disease Control and Prevention (CDC) and the AAP. We will also monitor local and regional trends, including data from the National Respiratory and Enteric Virus Surveillance System (NREVSS). At this time, use of more than five monthly doses of Synagis is not recommended by the U.S. Food and Drug Administration, CDC, or AAP to address interseasonal RSV.
If you have questions about Synagis, please call Customer Service at 1-888-YOUR-AH1 (AmeriHealth New Jersey), 1-800-275-2583 (AmeriHealth Pennsylvania), or 1-844-352-1706 (AmeriHealth Administrators).
To access the general request form or other drug order forms available through the Direct Ship Drug Program, visit our program webpages: