Synagis Prior Authorization
A Step-by-Step Prescribing Guide for CHP+ offered by Colorado Access Providers
Please use the following guide to help you order Synagis for your patient.
- Please complete the Synagis Prior Authorization form and prescription for Synagis for each patient and fax to Avella pharmacy at 877-470-7604. If the infant will need the medication to be administered at home, please indicate this on the form.
- For all infants meeting criteria, we will set up an authorization in our system for Avella and for the provider who will be administering the Synagis. A letter of authorization will be faxed to the provider.
- Avella will call you to get detailed information about the infant for each dose to be administered.
- Avella will ship the product to the provider’s office or to the patient’s home for administration and will bill Colorado Access directly.
- Click here to view the current clinical criteria.
If you have questions regarding this process, please contact:
- Colorado Access Pharmacy Services at 303-751-9005 (800-511-5010) or
- Avella at 877-470-7603