MedicaidPrior AuthMedium impact
Special Provider Bulletin - Synagis® Vaccine Benefit (B2100467 - 08/21)
Colorado Medicaid·CO · Pediatrics, Family Medicine·Pharmacy
Effective date
Aug 17, 2021
We identified it
Jun 20, 2026
Summary
Health First Colorado (Medicaid) is implementing a new prior authorization process for Synagis® RSV vaccine starting August 17, 2021, with an early season start due to atypical RSV activity. Different authorization vendors are required for home administration (pharmacy benefit) versus office/clinic administration (medical benefit).
Action Required
Immediately: Set up prior authorization workflow for Synagis® vaccine. For office/clinic administration, submit PARs to Kepro through Atrezzo portal using CPT 90378 (do not enter NDC). For home administration, submit to Magellan Rx Management using pharmacy benefit form. Maximum 5 doses per season with 26-day intervals. Only 50mg vials available this season. Verify patient meets AAP criteria before administration to avoid claim denials.