Synagis policy criteria for respiratory syncytial virus (RSV)

[chantell.reagan]

Based on the popularity of our previous analyses, we extended the review of biologic agents to palivizumab (Synagis) for respiratory syncytial virus (RSV). The latest treatment guidelines in this therapeutic area were issued by the American Academy of Pediatrics in 2003. Highlights from the guidelines are included in the attached document.

Our analysis of Synagis policies issued by 7 plans showed that all plans generally follow the AAP recommendation in their policies; however, there are subtle differences. Please see the attached document with the table, which compares Synagis policies.

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Sources:

AAP Policy Statement: Revised Indications for the Use of Palivizumab and Respiratory Syncytial Virus Immune Globulin Intravenous for the Prevention of Respiratory Syncytial Virus Infections

Blue Cross and Blue Shield of Florida. Medical coverage guidelines

The Regence Group. Synagis: RSV prophylaxis

Excellus BlueCross BlueShield. Synagis policy

BlueCross BlueShield of Alabama. Immune prophylaxis for RSV: Synagis policy

Wellpoint, NextRx. Synagis policy

Aetna. Clinical Policy Bulletin: Synagis

Cigna. Synagis Coverage Position

[chantell.reagan]

Updates to the recommendations on the use of Synagis in RSV was published by the American Academy of Pediatrics this month. One major change includes: infants born from 32 weeks 0 days of gestation through 34 weeks 6 days of gestation who qualify for prophylaxis should receive prophylaxis only until they reach age of 90 days or a maximum of 3 doses, whichever comes first. The previous guidelines recommended 5 months of prophylaxis.

We analyzed 10 local and national plan policies and found that 6/10 had made changes in accordance with the update, while 4/10 had not updated their policies yet.

Have you updated your Synagis policies to reflect these new guidelines? How do you think this change might affect your utilization/spend?

Sources:

Aetna. Clinical Policy Bulletin: Synagis

BlueCross BlueShield of Alabama. Immune prophylaxis for RSV: Synagis policy

BlueCross and BlueShield of Florida. Medical coverage guidelines

BlueCross and BlueShield of Mississippi. Synagis policy

BlueCross and BlueShield of Texas. Synagis policy

Cigna. Synagis Coverage Position

Excellus BlueCross BlueShield. Synagis policy

Oxford/United Healthcare. Synagis policy

The Regence Group. Synagis: RSV prophylaxis

Wellpoint, NextRx. Synagis policy

News article/post 9/09