MedicaidPrior AuthMedium impact
BT202213: IHCP to resume RSV season limits for palivizumab PA requests
Indiana Medicaid (IHCP)·IN · Pediatrics, Pulmonology, Critical Care·Provider Bulletin
Effective date
Apr 1, 2022
We identified it
Jun 19, 2026
Summary
IHCP (Indiana Medicaid) is resuming seasonal limits for palivizumab (Synagis) prior authorization requests effective April 1, 2022. The RSV season limits will return to the standard November 1 - March 31 timeframe, with PA requests accepted starting October 1, 2022 for the next season.
Action Required
By April 1, 2022: Billing team must note that palivizumab (Synagis) PA requests for IHCP members will be subject to seasonal limits (Nov 1 - March 31). For the 2022-2023 season, submit PA requests starting October 1, 2022 for claims with dates of service on or after November 1, 2022. Contact OptumRx at 855-577-6317 for FFS members or the appropriate MCE for managed care members.