Forms & Documents

Complete prior authorization forms and fax them to Navitus at 855-668-8551. All approved Synagis requests will be dispensed by Avella Specialty Pharmacy. If you wish to have a home health agency administer Synagis to your patient, please indicate that the medication will be shipped to the patient’s home. Upon prior authorization approval, Navitus will notify Avella, who will fax a home health request to set up the services. Our utilization management team will work to set up a home health agency to visit the patient’s home and administer the medication.

Synagis is covered for eligible patients through the Colorado Access pharmacy benefit. The specific criteria for approval can be found here. Prior authorization forms should be faxed to Navitus at 855-668-8551.