MedicaidPrior AuthMedium impact
Special Provider Bulletin - Synagis® and Seasonal Influenza Vaccines (B2000454 - 10/2020)
Colorado Medicaid·CO · Pediatrics, Pulmonology, Cardiology·Pharmacy
Effective date
Nov 2, 2020
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) will begin accepting prior authorization requests for Synagis® (RSV prevention vaccine) on November 2, 2020, with the 2020-2021 season running November 16, 2020 through April 16, 2021. Prior authorization is required for both pharmacy and medical administration, with strict eligibility criteria based on American Academy of Pediatrics guidelines for high-risk pediatric patients.
Action Required
By November 2, 2020: Billing team must implement prior authorization workflow for all Synagis® claims through appropriate vendors - submit pharmacy benefit PARs to Magellan Rx Management via fax (1-800-434-5881) for home administration, and submit medical benefit PARs to eQHealth Solutions via eQSuite portal for office/outpatient administration. Update encounter forms to remind providers that maximum 5 doses per season are allowed with 26-day minimum intervals. Claims without prior authorization will be denied.