Use of Palivizumab Prophylaxis to Prevent Hospitalization from Severe RSV Infection

Oct 28, 2022

The Office of MaineCare Services (OMS), in coordination with their Pharmacy Benefits Manager Change Healthcare (CHC), review data from the National Respiratory and Enteric Virus Surveillance System (NREVSS) to track the epidemic season for Respiratory Syncytial Virus (RSV). Palivizumab is indicated for the prevention of serious lower respiratory tract disease caused by RSV in infants. Peak RSV activity typically occurs between November and March. Due to a shift in RSV circulation, the American Academy of Pediatrics (AAP) supports the consideration of palivizumab in patients who would be candidates per current eligibility recommendations as outlined in our Prior Authorization Form (PA).   

MaineCare is currently accepting PA requests for coverage of palivizumab due to the increasing trend of positive RSV tests. The clinical benefit of palivizumab therapy is best realized by timing the administration to coincide with the peak of RSV activity. OMS and CHC will continue to monitor RSV activity and may end the atypical inter-seasonal palivizumab approvals when the percent positives on antigen tests is ≤ 10% for 2 weeks or the percent positives on PCR tests is ≤ 3% for 2 consecutive weeks. 

For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-888-420-9711. Maine providers can also send inquiries via email to PBA_Helpdesk@changehealthcare.com.