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Health Partners Plans to start Synagis Prior Authorizations Process on October 15

Health Partners Plans (HPP) will start the annual Synagis Prior Authorization process on October 15, 2019, two weeks before the respiratory syncytial virus (RSV) season begins. Synagis (palivizumab) is a monoclonal antibody indicated for the prevention of serious lower respiratory tract disease caused by RSV in infants and children at high risk. The RSV season begins November 1, 2019, and runs through March 31, 2020.


Synagis reduces RSV hospitalization among high-risk infants and children. In the informed opinion of the Committee on Infectious Diseases and the Bronchiolitis Guidelines Committee, as well as others participating in the current statement, Synagis use should be restricted to appropriate populations, including:

  • Infants who were born before 29 weeks, 0 days’ gestation and are younger than 12 months
  • Preterm infants with CLD of prematurity (defined as birth at <32 weeks, 0 days’ gestation and a requirement for >21% oxygen for at least 28 days after birth) who are younger than 12 months at the start of the RSV season.
  • Infants who satisfy the CLD of prematurity definition and continue to require medical support during the 6-month period before the start of the second RSV season and who are between the ages of 12 months and 24 months.
  • Certain children with hemodynamically significant CHD who are younger than 12 months.
  • Children who will be profoundly immunocompromised during the RSV season and are younger than 24 months.
  • Infants with congenital heart disease (CHD), chronic lung disease (CLD) or another condition (such as pulmonary abnormality or neuromuscular disease) and were born at 29 weeks, 0 days’ gestation or later.


If you believe that Synagis is warranted after reviewing the patient’s medical records, please complete the Synagis Prior Authorization Request Form from our Drug Specific Prior Authorization web page and fax it to 1-866-240-3712. After we receive the completed form, Greater Philadelphia Pharmacy will make arrangements to have the vaccine available for the patient in your office or through a home care provider. If you prefer to use another specialty pharmacy, please indicate this preference on the form.

Note that only participating, contracted specialty pharmacies may dispense Synagis. Please contact our Pharmacy Department at 215-991-4300 and we will be happy to assist you with any questions you may have.