Physician Ordering Info
Rady Children's HomeCare will follow AAP Red Book 2009 guidelines to assist physicians in identifying high-risk candidates for RSV Prophylaxis. Synagis (Palivizumab) is the monoclonal antibody given intra-muscularly (IM) on a monthly basis through the RSV season. The AAP recommends a regional calendar season of November through March for San Diego, Imperial and Riverside Counties. Physicians should discuss with families the benefits, risks and commitment associated with monthly injections. Rady Children's HomeCare has also developed a Synagis Parent and Family Information sheet to help with this process. Childhood vaccinations are not affected by Synagis administration.
AAP Red Book 2009 & CCS/Medi-Cal Guidelines for Synagis prophylaxis:
- Children 24 months of age or younger at the start of RSV season with Chronic Lung Disease (CLD) requiring medical treatment (supplemental oxygen, bronchodilator, diuretic, corticosteroid or other treatment) within six months before the anticipated start of RSV season. A maximum of five monthly doses is recommended.
- Infants born at 28 weeks 6 days of gestation or earlier and who are less than 12 months of age at the start of RSV season. A maximum of five monthly doses is recommended.
- Infants born at 29 to 31 weeks, 6 days of gestation who are less than 6 months of age at the start of RSV season. A maximum of five monthly doses is recommended.
- Infants born at 32 weeks to less than 35 weeks of gestation and who are born less than 3 months before the onset of during the RSV season and for whom at least one of the following risk factors are present:
Infant attends childcare, defined as a home or facility where care is provided for any number of infants or young toddlers.
Infant has a sibling less than 5 years old or there is a child less than 5 years old living permanently in the household.
- These infants should receive prophylaxis only until they reach 3 months of age and should receive a maximum of 3 doses.
- Infants born before 35 weeks of gestation and who are in the first year of life who have either congenital abnormalities of the airway or a neuromuscular condition that compromises handling of respiratory secretions. A maximum of five monthly does is recommended.
Rady Children's HomeCare will obtain authorization from contracted third-party payers. The charge for a 100mg vial of Synagis is currently $2,388.30. If your patient has no insurance funding, please refer immediately to the Medimmune Assistance Program at 877-633-4111 to register the patient and receive application materials. If you need assistance with this process, please contact your local Medimmune representative.
To initiate Synagis injections through Rady Children's HomeCare:
- Please complete the Synagis Prescription completely with all information and MD signature. Please FAX prescription to 858-966-4956.
- Rady Children's HomeCare will obtain third-party payer authorization. Authorization may take up to six weeks. Rady Children's HomeCare will schedule the patient for injections after the authorization is obtained. Monthly injections will begin and end as ordered on the Synagis Prescription.
For insurance authorization questions or concerns, please contact:
A - Cn Artemiza, ext. 3535
Co-Ki Denise, ext. 6961
Kj-Ph Nina, ext. 6924
Pi-Z Melissa, ext. 3542
For clinical questions or concerns, please contact:
- HomeCare 858-966-4941