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Respiratory Syncytial Virus



This RSV season 

Aetna Specialty Pharmacy® understands the special needs of children at risk for severe Respiratory Syncytial Virus (RSV). To help, we dispense the preventive drug Synagis.®

We also offer personal support for you and your patients.

 
Things to keep in mind this season?

Please bookmark this page.

Please review  Aetna's Clinical Policy Bulletin(CPB) #0318. It outlines the criteria patients should meet for Synagis to be medically appropriate.

The CPB reflects current data from the American Academy of Pediatrics ((AAP) and the Centers for Disease Control and Prevention (CDC).

Key criteria this RSV season: 

  • Three ranges for prematurity. This affects the number of doses approved ranging from one to five doses. Some infants will be approved only up to 3 months of age.
  • Decrease in qualifying risk factors. There are now two qualifying risk factors instead of five; and infants in this gestational age range will now only need to have one of them.
  • Criteria changes. There is no change in the congenital heart disease criteria. Chronic lung disease has been altered to remove cystic fibrosis as qualifying criteria.
  • Continued handling of precertification and home health care requests. Home Health care requests will complete faster because our nurses review them instead of sending to a medical director.

How to order

Follow these three easy steps to start your patients on service with Aetna Specialty Pharmacy. We'll take care of everything else.

1. Print and complete the appropriate form for each patient (based on situation below).  You may send your in-season requests at any time. Please be sure to indicate that you are requesting an in-season start.

2. Indicate delivery arrangements on the form.

3. Fax in your form as indicated.

To initiate precertification or inquire about pending precertification, call an Aetna  representative toll free at 1-866-503-0857.




Next-day delivery

Complete orders received before 3 p.m. ET are scheduled for next-day delivery.


Refills

Authorizations for Synagis® are completed when you place your patient's first order.

All additional doses of Synagis® that you request will be reviewed by a medical director. Each request will be considered on a case-by-case basis, in accordance with the state virology maintained by the CDC.

A nurse will call your patient's caregivers to let them know when their refill has mailed.


An experienced support team

Our RSV specialists will:

  • Handle any prior authorization issues that may arise.
  • Record each child's current weight to ensure proper dosing.
  • Process insurance paperwork and coordinate benefits.
  • Provide you and your patients with information regarding manufacturer and foundation financial assistance programs.
  • Arrange delivery in time for each scheduled appointment.
  • Work with you to coordinate the start of therapy.
Assessment

After you place your patient's order, a patient care coordinator (PCC) will call the patient's caregivers. The PCC will confirm key information like the child's weight, any allergies and shipping address.


Open lines of communication

A nurse who specializes in RSV will call the patient's caregivers as often as needed. If your patient's caregivers express any concern about their child's medication or dose, we will contact you to discuss.


Product integrity

We take care of your patient's medications. Our pharmacists will double-check each order to make sure it's right before it goes out the door. Our special packaging keeps medications at the right temperature.