Synagis (palivizumab)

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

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 MFC at 202-243-5496.

If you have questions for MFC, call 855-210-6203.

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: 08/30/19