Respiratory Syncytial Virus

RSV season 2009-2010

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.

 
What’s new this season?

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There are significant new updates under way to Aetna’s Clinical Policy Bulletin (CPB) #0318 that outline 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 changes:

• There are now three different ranges for prematurity, which will affect the number of doses approved.
• Some infants will receive three doses and only for up to 3 months of age. Others will receive five doses and must be within 12 or 6 months of age at the start of your region’s RSV season.
• There is a decrease in qualifying risk factors from five to two. Only one of the two risk factors is required for the patient to qualify.
• Chronic lung disease has been altered to remove cystic fibrosis as one of the qualifying criteria.  (There is no change in the congenital heart disease criteria.)
• We will continue to precertify and staff your home health care requests. We will complete these requests more quickly this year because our precertification nurses can review them instead of a medical director.

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.


What to expect

After we receive a new order for Synagis®, we will send your patient's caregivers a welcome packet that includes:

• A welcome letter
• A magnet that lists RSV warning signs and our toll-free number
• Directions on how to enroll in Helping Hand^SM, a free program from MedImmune, the maker of Synagis®. Participants get a free germ protection kit and access to helpful information.

• 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.

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.

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.

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.