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Subject: Respiratory Syncytial Virus (RSV) Season Ended on March 1
Date: March 14, 2023
Attention: Providers
Effective Date: March 1, 2023
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Effective March 1, 2023, the Texas Health and Human Services (HHSC) closed Respiratory Syncytial (RSV) season’s Synagis prophylaxis therapy in all regions. This is in response to continued decrease in RSV positivity below the threshold for 2 consecutive weeks. The traditional 2022-23 RSV season began on October 17, 2022. This was considered a separate season from the unusual inter-seasonal RSV activities during the summer of 2022. HHSC will continue to monitor RSV activities and notify the public with updates as needed.
How this impacts providers:
- Any doses and Prior Authorizations requests from March 1, 2023 and beyond will be denied.
- Members may not receive any additional doses through Medicaid once HHSC declares RSV season to be over. If any members were approved for 5 doses in February of 2023 and did not complete the doses by the end of February, the remaining doses may not be approved beyond this date.
- Depending on when the member started therapy, they may receive less than the 5 monthly doses allowed before the season ends.
- RSV season is dictated by the state and HHSC/VDP. Prescribers and pharmacies were made aware that the duration of approval is limited to the local RSV season and it was dictated in the approval letter.
- Any escalations will be subjected to an appeal and approval by the MCO.
Next steps for providers: Providers should continue to follow American Academy of Pediatrics guidelines when prescribing and should share this communication with their staff. Providers may refer to the following link regarding RSV season updates.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.