Synagis-Information for 2024-2025

Alabama Medicaid has updated its prior authorization criteria for Synagis^®. Alabama Medicaid follows the 2014 updated American Academy of Pediatrics (AAP) guidelines regarding Synagis^® utilization.

• Prior Authorization Form for Synagis^® - Effective 10/1/24
• Prior Authorization Criteria for Synagis^® - Effective 10/1/24
• Instructions PA Worksheet - Effective 10/1/24
• Instructions PA Form Appendix A ICD-10 - Effective 10/1/24

• ALERT - Synagis^® 2024-2025 - Updated 9/17/24
• Letter - Regarding unused vials