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Este documento define el uso de Synagis (palivizumab) en niños de alto riesgo y establece los criterios de autorización para la medicación no formulary. Incluye información sobre la administración,

How to fill out synagis enrollment - partnershiphp

How to fill out Synagis Enrollment

1. Obtain the Synagis Enrollment Form from your healthcare provider or the manufacturer's website.
2. Fill out the patient's personal information including their name, date of birth, and address.
3. Provide the insurance details and confirm coverage for Synagis.
4. Include the physician's information who is prescribing Synagis.
5. Document the medical history relevant to the patient's need for Synagis, including any risk factors.
6. Sign and date the enrollment form as required.
7. Submit the completed form to the designated health plan or provider specified on the form.

Who needs Synagis Enrollment?

1. Infants and young children who are at high risk for severe respiratory syncytial virus (RSV) disease.
2. Premature infants born at or before 28 weeks of gestation.
3. Infants under 12 months of age with certain medical conditions such as congenital heart disease or chronic lung disease.

People Also Ask about

How much does Synagis cost in the US?

SYNAGIS® (palivizumab) may be covered under a patient's pharmacy or medical benefit. Sometimes SYNAGIS is covered under both benefits, or by more than 1 plan, depending on the patient's insurance. To ensure timely approval for SYNAGIS, collect all prescription and medical benefit information for appropriate patients.

How much does SYNAGIS cost in the US?

The cost for Synagis (100 mg/mL) intramuscular solution is around $1,910 for a supply of 0.5 milliliters, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans.

How do you qualify for SYNAGIS?

SYNAGIS gives babies who are born prematurely (at or before 35 weeks, and who are 6 months of age or less at the beginning of RSV season) the virus-blocking antibodies they lack, helping protect their vulnerable lungs from RSV.

Who qualifies for Synagis?

SYNAGIS gives babies who are born prematurely (at or before 35 weeks, and who are 6 months of age or less at the beginning of RSV season) the virus-blocking antibodies they lack, helping protect their vulnerable lungs from RSV.

What is the schedule for SYNAGIS?

It is very important your child receives Synagis doses on time each month (every 28 to 31 days). If your child is ill at the time the injection is due, please tell the nurse who gives the shot. Depending on your child's condition, we may decide NOT to give Synagis that day.

Is SYNAGIS covered by insurance?

SYNAGIS® (palivizumab) may be covered under a patient's pharmacy or medical benefit. Sometimes SYNAGIS is covered under both benefits, or by more than 1 plan, depending on the patient's insurance. To ensure timely approval for SYNAGIS, collect all prescription and medical benefit information for appropriate patients.

Who qualifies for RSV vaccine?

The cost for Synagis (100 mg/mL) intramuscular solution is around $1,910 for a supply of 0.5 milliliters, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans.

For pdfFiller’s FAQs

What is Synagis Enrollment?

Synagis Enrollment refers to the process of registering patients for the administration of Synagis (palivizumab), a medication used to prevent serious respiratory syncytial virus (RSV) infections in high-risk infants and children.

Who is required to file Synagis Enrollment?

Healthcare providers, including physicians and hospitals, who are prescribing Synagis for eligible patients must complete and file the Synagis Enrollment.

How to fill out Synagis Enrollment?

To fill out Synagis Enrollment, healthcare providers must complete the enrollment form accurately with patient details, medical history, and insurance information, ensuring all required fields are filled to process the enrollment properly.

What is the purpose of Synagis Enrollment?

The purpose of Synagis Enrollment is to ensure that eligible high-risk infants and children receive access to the necessary RSV prophylaxis and to facilitate proper management and reimbursement processes for the administration of Synagis.

What information must be reported on Synagis Enrollment?

The information that must be reported on Synagis Enrollment includes patient demographics, medical history indicating eligibility, dosage information, prescribing physician details, and insurance coverage data.