Why is synagis so hard to get?

Re: Why is synagis so hard to get?

• ssg73

  September 2010

  I don't think she would qualify see my post below on the guidlines.  That said you could push your dr to apeal the denial (which would mean they would have to apply for it first).  The reason it is so hard to get is that it is very expensive about $5000/shot and most babies will need the 5 shots.  It used to be easier to get them but the AAP changed the guidlines last year.  Pretty much it comes down to money and a cost risk analysis.  Is it less expensive to pay for your babies hospital stay due to RSV or is it cheaper to prevent complications from RSV with synagis?  For babies over 32 weeks  or for babies 29-32 weeks but over 6 months at the start of rsv season  it is cheaper to just pay for the hospital stay than pay to have all those babies have the shot who may never get rsv.  Synagis is a monoclonal antibody not a vaccine so it only lessens the effects of rsv not prevent a baby form getting it.

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• ShannonSky member

  September 2010

  Ditto everything ssg73 said. It doesn't sound like you'd qualify for insurance coverage, we didn't either and DD was born just under 34 weeks in Sept of last year.

  

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• Susan_KW member

  September 2010

  I think it would be very hard for you to qualify too.  I doesn't sound like your daughter has ongoing respiratory issues nor any heart issues.  They are pretty strict with the guidelines ... a 32w1d preemie under 6 months would have a really hard time getting approved even.

  It's a very expensive shot ... and insurance companies do not want to pay for it unless it is within the guidelines.  
  

  

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• ahava2005

  October 2010

  My insurance wouldn't cover you.  they only cover babies more than 31 weeks 6 days if there are ongoing respiratory problems.

  My girls got them last year (born 30 weeks) but were refused for this year because they don't have any lung problems.

  It is extremely expensive, which is why there are very strict guidelines.  Its not actually a vaccine, its an antibody a pregnant woman makes in her final weeks of pregnancy that gets passed along to the fetus.  If the fetus is born too early, it obviously doesn't get the antibody.  At 35 weeks, they would assume your baby will have gotten it from you and would be unlikely to be any benefit anyway. 

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• Temp984666312503071 member

  October 2010

  My DD was born at 35w4d and was 5 pounds 1 ounce.  She didn't have the breathing issues your DD did but she was much much smaller when RSV season hit.

  She did not recieve synagis.  If I remember correctly she didn't qualify for it based on when she was born.  I didn't push it.

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• MrsFontenot member

  October 2010

  I just barely made it.  My LO was born at 31w1day.  As the PPs have stated, most insurances tend to be really adamant about the guidelines b/c of the cost of the shot. 
  

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