Synagis (palivizumab) — Clinical coverage criteria for RSV immunoprophylaxis
Clinical coverage criteria and coding for Synagis (palivizumab) for prevention of severe RSV disease in high-risk infants and young children; applies to UnitedHealthcare Medical Benefit Drug Policy populations except where state-specific exceptions apply.
Replaced criterion requiring prior nonreceipt of Beyfortus (nirsevimab-alip) with a requirement that the patient has not previously received Beyfortus or Enflonsia (clesrovimab-cfor) during or entering the current RSV season.
Revised language about RSV seasonality to permit providers to adjust administration schedules based on local epidemiology and to note different seasonality patterns in tropical climates, Alaska, and certain U.S. territories.
Updated Background, Clinical Evidence, and References sections to reflect current information including new professional society and federal advisory committee recommendations.
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