An effective but expensive drug used to prevent RSV infection during the flu season in young (typically under 2 years of age), high risk (often premature, with compromised respiratory or heart function) children. Children receiving Synagis require a monthly dose by injection; the appropriate number of doses and amount of each dose varies among patients. Most health plans require prior approval for prescribing Synagis. This prior approval process is typically manual and expensive, all the more so if the health plan attempts to manage dosing.
With Infina Connect’s Synagis ePA solution, initial requests are submitted online with the majority of approvals issued automatically, in conformance with Red Book® criteria. Moreover, individual dose requests are submitted online, allowing more exacting management of the number of doses for each patient and the amount of each dose. Finally, the manual review of requests that are not automatically approved is facilitated by an online module for medical reviewers, enabling them to track all such requests, their status, the exchange of information with the requesting prescriber, and the final decision.
The Synagis ePA solution streamlines this prior authorization process for prescribers and payers, while delivering an appropriate and accurate authorization to the Synagis pharmacy far more quickly than possible with the paper and fax alternative.
NC Medicaid reported a $2.5 million cost savings during the first season the system was deployed.