Monday, October 21, 2013

Synagis Insurance Approval

Obtaining Synagis for the prevention of complications from respiratory syncytial virus (RSV) infection is a multi-step process. Before ordering Synagis, pediatricians typically determine which children in their patient population are at increased risk for the illness. Pediatricians then seek health insurance approval for each high-risk child. Once the insurance company approves the drug, the pediatrician orders it for that at-risk child.

For months, I have been mentioning our preemie's need for Synagis to our pediatrician. Our preemie was born at 28 weeks weighing one pound, eight ounces. Like many other preemies, her lungs are very immature and she lacks infection-fighting antibodies.

Our pediatrician wrote to our insurance company and provided its Specialty Pharmacy Division with documentation and rationale concerning our baby's need. Thankfully, we received approval from the health insurance company. The letter indicates that our preemie has been approved for Synagis for the entire RSV season, which usually begins in November and conculdes at the end of March.  This means that our baby will receive shots every 28-30 days during this period. We are currently waiting for the Synagis to be delivered to our pediatrician's office so that we can schedule our baby's first dose.

Is your baby at high-risk for RSV?  Have you discussed Synagis with your pediatrician?  Did you find the approval process to be difficult?

1 comment:

  1. So glad your pediatrician was able to get approval for the whole season of Synargis instead of having to get approval every month.