Synagis®: Insurance coverage | Support information and helpful tips

While many health plans cover Synagis, the levels of coverage and the requirements for getting it can vary. Use this checklist to help you iron out any potential problems.

Is all of your health plan information correct and up to date?
Have you reviewed all of your health plan benefits carefully?
Did you double check all of your claims or reimbursement forms?
Does your doctor have backup information to support your baby's case?

Q. Is all of your health plan information correct and up to date?

A. Many employee plans are open to changes during October and November. But if your insurance plan changes at any time, let your doctor's office know immediately. If you're enrolled in a state Medicaid program, you need to let your doctor know before making any changes.

Q. Have you reviewed all of your health plan benefits carefully?

A. Ask your employer (if appropriate) and your insurance company if Synagis is covered and how they determine if a baby is eligible for Synagis. Share this information with your doctor.

Q. Did you double check all of your claims or reimbursement forms?

A.Missing or incorrect information on insurance forms can lead to delayed processing and denials. Also make sure that your doctor has all of your baby's latest medical information.

Q. Does your doctor have backup information to support your baby's case?

A.If there's a chance your baby might be denied coverage, your doctor can provide studies on RSV and RSV risk factors, or a letter of medical necessity –if appropriate—to help support your case.

Synagis Reimbursement Hotline (1-877-480-8082)
For doctors, office staff, and patients who need assistance with patient benefit verifications, distributor triage, preauthorization assistance, denied claims and appeals.
MedImmune Assistance Program (1-877-480-8082)
For eligible patients who do not have health insurance (including Medicaid and Medicare) and are unable to get coverage for Synagis.
Patient Access Network Foundation (1-866-316-7263)
For patients with high co-pays and deductibles, this nonprofit organization may be able to provide support.

The appeals process

If your insurance plan denies coverage or reimbursement for Synagis, you may be able to appeal the decision. Working together with your insurance company and your doctor is the best plan of action. Your doctor's office may contact the reimbursement hotline to discuss the appeals process.

Alison's story
"The doctors in the NICU weren't sure if my insurance would cover Synagis for Christopher. But I knew that RSV was serious enough to ask my pediatrician about it..."

Important Safety Information

Synagis® (palivizumab) is indicated for the prevention of serious lung infections caused by respiratory syncytial virus (RSV) in children at high risk of RSV disease. Synagis is given as a shot, usually in the thigh muscle, each month during the RSV season. The first dose of Synagis should be given before RSV season begins. Children who develop an RSV infection while receiving Synagis should continue the monthly dosing schedule throughout the season. Synagis has been used in more than one million children in the U.S. since its introduction in 1998.

Synagis should not be used in patients with a history of severe prior reaction to Synagis or its components. Cases of severe allergic reactions such as anaphylaxis and other types of hypersensitivity reactions have been reported with Synagis. These reactions may occur when any dose of Synagis is given, not just the first one. Another serious side effect, which may lead to unusual bruising and/or groups of pinpoint red spots found on the skin, has been reported.

Most common side effects with Synagis may include upper respiratory tract infection, ear infection, fever, and runny nose. In children born with heart problems, Synagis was associated with reports of low blood oxygen levels and abnormal heart rhythms. Side effects, such as, skin reactions around the area where the shot was given (like redness, swelling, warmth, or discomfort) have also been reported.