MedicaidPrior AuthMedium impact
BT202153: Providers may now request palivizumab RSV prophylaxis for high-risk IHCP members
Indiana Medicaid (IHCP)·IN · Pediatrics, Pulmonology, Critical Care·Provider Bulletin
Effective date
Jun 23, 2021
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) now allows providers to request prior authorization for palivizumab (Synagis) RSV prophylaxis for high-risk members outside the normal RSV season, effective June 23, 2021. This extends coverage beyond the typical November-March timeframe due to unusual statewide virology data.
Action Required
Immediately: Providers treating high-risk IHCP members can now submit prior authorization requests for palivizumab (Synagis) outside normal RSV season. For fee-for-service members, use Synagis PA Form from OptumRx website via in.gov/medicaid/providers. For HIP, Hoosier Care Connect, or Hoosier Healthwise members, contact the member's managed care entity for prior authorization. Clinical questions should be directed to OptumRx at 855-577-6317.