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Synagis (palivizumab)

MedStar Family Choice follows the American Academy of Pediatrics 2014 guidelines for Synagis (palivizumab) administration (see link below). 

Requests for Synagis (palivizumab) require a completed 2016-2017 Synagis® Seasonal Respiratory Syncytial Virus Enrollment Form (see link below). Please fax completed forms to Caremark Specialty Pharmacy at 877-552-2907 and a second copy to MFC at (410) 933-2274.

If you have questions for MFC, call 410-933-2200, option 1.

Click here for the American Academy of Pediatrics 2014 Synagis (palivizumab) Guidelines.

Click here for the Synagis (palivizumab) Prior Authorization Form.

Information current as of: 12/30/16