Second Season of Synagis?

Brummy14 · September 2013

Per the latest eligibility criteria for Synagis, our girls will not qualify this year by a matter of *days* (of course). Per the guidelines below, had they been born 4 days earlier they would have been less than 12 months of age as of Nov 7th. But, because they were born at 29w3d, they will obviously not make the cut-off. Ugh.

They don't have any chronic underlying issues that would qualify them other then their prematurity. Anyone had any success getting their docs to help them get that second season in a similar situation -- is it something I should be going after?

Infants with a history of premature birth


4.	Any infant up to 12 months of age, born at 28 weeks or less gestation
	* Up to five (5) monthly doses will be approved.
5.	Any infant up to 6 months of age, born 29 to less than 32 weeks gestation
	* Up to five (5) monthly doses will be approved.

Missa_g · September 2013

Our boys didn't qualify last year due to the ridiculous cutoff. We had no success petitioning for it. I'm sorry.

DrRx · September 2013

I don't think that my daughter will qualify for a 2nd season of Synagis even though she came home from the NICU last year on oxygen. She was born at 26w2d, but since she is older than 12 months and hasn't been on oxygen in the last 6 months, she will likely not qualify. My pedi is still going to petition for her, but told me to not hold my breath.

thishappyhouse · September 2013

I was unsuccessful last year. Went through 6 rounds of appeals with our insurance, 3 rounds of appeals with our prescription plan and by the time I could appeal to my Husbands company's medical fund it was already the end of Feb. It was so so frustrating and scary. Start now!

My DD (born at 25w 0d, 650 g, 124 days in the NICU (100+ days on o2) turned one on October 22nd. Had she been born 9 days later on November 1 she would have (likely) been a healthier 26.5 weeker and would have qualified for her 2nd season. Most of our NICU friends in a similar boat did have successful appeals but even with some very serious letters from her drs we just got denial after denial.

The rsv/flu season was horrible last year so we just didn't go anywhere and seriously limited visitors. Thankfully she stayed healthy.

There are some sample RSV letters floating around. Take a look at those when drafting your appeals. good luck!

Brummy14 · September 2013

Sahara78 said:
Is this your insurance policy's guideline? DD was born at 29w2d and she received 5 doses; some of them were after she was over 6 months old. My pediatrician's office had a form they fill out (and I signed) for all of their Synagis patients. Were your girls given it last year?

Yeah, you can get shots after the cutoff, since the age determination is made as of the beginning of the season (usually the first week of Nov). So, as long as you meet the criteria as of that date, you're good for the season.

Brummy14 · September 2013

Thanks guys, I wasn't optimistic, but figured I'd ask. I'll check with our docs, but also not expecting any miracles. We are already planning on going on lockdown part deux as of Oct 1st.

I feel like stupid flu season just ended! Only letting my parents and our nanny visit, since they are our primary caregivers.

PhillyGal34 · September 2013

DS was born at 31w 5d at the beginning of June. Our RSV season starts in November I believe so he was under 6 months and got all 5 doses. our insurance said he could get a second year most likely but our Pedi doesn't believe they will approve it so we are trying but not holding out hope.

Good luck

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