Misc Antivirals

• Palivizumab Policy Update - Feb 03, 2022
• Synagis Policy Update - Sep 23, 2014
• Policy Evaluation: Palivizumab Prior Authorization - Sep 26, 2013

• November 2023 - Prevention of Respiratory Syncytial Virus (RSV) Infection: New Products and Recommendations
• April 2023 - COVID-19 Therapeutics Update: Where Are We Now?
• November 2021 - Anti-SARS-CoV-2 Therapeutics can Effectively Treat, Prevent COVID-19 Infection
• November 2014 - Guidance Update for Prophylaxis of Respiratory Syncytial Virus
• January 2012 - RSV Prophylaxis: Updates and Recommendations

Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the Non-Preferred Drugs in Select PDL Classes prior authorization criteria. New drugs will be listed as N until reviewed by the P&T Committee and are subject to the New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.