Price Increase For Synagis Injectable

 

Effective for dates of service on or after October 15, 2011, the South Carolina Department of Health and Human Services (SCDHHS) will increase the rate for Synagis to the current Average Wholesale Price (AWP) minus 18%.  The new rates for 100mg vial will increase from $1,995.36 to $2,192.89.  The 50mg vial will increase from $1,056.71 to $1,161.31.

 

SCDHHS will continue to utilize the American Academy of Pediatrics (AAP) 2009 guidelines for the administration of Synagis®, which state the recommendations remain unchanged for infants with congenital heart disease (CHD), chronic lung disease of prematurity (CLD [formerly called bronchopulmonary dysplasia]), and birth before thirty-two (32) weeks 0 days gestation.  A maximum number of five (5) doses is allowed for infants with hemodynamically significant CHD, CLD, or birth before 32 weeks 0 days gestation.  A maximum of three (3) doses is allowed for infants with a gestational age of 32 weeks and 0 days to 34 weeks and 6 days who do not have CLD or hemodynamically significant CHD but have at least one of two (AAP) defined risk factors:

 

  • Infant attends child care, or
  • Siblings or other young children who permanently live in the household and who are less than 5 years of age.

 

Infants with a gestational age of 32 weeks 0 days through 34 weeks 6 days who do not have CLD or hemodynamically significant CHD born within 3 months before the start of the Respiratory Syncytial Virus (RSV) season or at any time throughout the RSV season, will qualify for prophylaxis under these recommendations if they have at least one of the two risk factors listed above.  These infants should receive a maximum of three (3) doses.

 

The AAP guidelines are available at http://www.aap.org.  Prior approval by the SCDHHS Medical Director will still be required for any request to administer Synagis outside of the AAP guidelines.

 

If you have any questions or concerns regarding this bulletin, policy, or Medicaid billing, please contact your Program Representative in the Office of Hospitals, Dental, Transportation, and Durable Medical Equipment at (803) 898-2665.

 

Thank you for your continued support and participation in the South Carolina Healthy Connections Medicaid program.

 

                                                                                                                                /s/

                                                                                    Anthony E. Keck

                                                                                    Director

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