Respiratory Syncytial Virus (RSV) Season and Synagis Prior Authorization Ends March 31 for Most Regions

Date: March 28, 2025

Attention: All Providers

Effective date: March 31, 2025

Call to action: Effective March 31, 2025, Texas Medicaid will end the 2024-25 Respiratory Syncytial Virus season for most state health service regions. Prior authorization requests for Synagis will no longer be accepted or reviewed.

The season will continue to end on April 14, 2025, for counties in state health regions 1 (High Plains), 2 (Northwest Texas), 9 (West Texas), and 10 (Upper Rio Grande). Refer to this season's schedule for dates, regions, and counties.

How this impacts providers:

• Any doses and Prior Authorizations requests from March 31, 2025 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 2025 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.texaschildrenshealthplan.org/provideralerts.