New Synagis Prior Authorization Review and Billing Process: Synagis Moving From Medical Benefit to Pharmacy Benefit

November 29, 2019

The purpose of this update is to notify Blue Cross and Blue Shield of New Mexico (BCBSNM) independently contracted providers about a change to the BCBSNM Centennial CareSM process for requesting coverage of Synagis.

Currently, Synagis requests are reviewed by BCBSNM clinical teams and if approved, the claims are processed through the medical benefit. In order to streamline this process and ensure faster prior authorization decisions (24-hour turnaround time), BCBSNM will move Synagis from a medical benefit to a pharmacy benefit effective 11/15/2019. This change should also result in faster delivery of the medication to our contracted providers.

Prior authorization requests should be submitted to Prime Therapeutics. Prior Authorization Requests can be submitted by fax 877-480-8130, called in at 866-202-3474 (TTY/TDD 711) or submitted electronically on MyPrime Learn more about third-party links or CoverMyMeds login page Learn more about third-party links.

In order for BCBSNM to cover Synagis, the prescriptions must be filled at AllianceRx Walgreens Prime. For additional support, please call 877-627-6337 (TTY: 711).

If you have any questions related to this process change, please call the Prime Contact Center at 800-821-4795.

Such services are funded in part with the State of New Mexico.