Specialty Drug


PALIVIZUMAB is an antibody. It is used in infants and children to prevent severe cases of respiratory syncytial virus (RSV) infection. Children treated with this medicine may still get RSV but will not get as sick as if they were not treated at all. This medicine does not protect against other infections. Compare monoclonal antibodies.

Palivizumab Medicare Coverage


Does Medicare cover Synagis?

98% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Synagis co-pay with Medicare?

It depends. Which coverage stage are you in? Click on a tab below…

Donut Hole
Post-Donut Hole
Co-Pay Range
$1422 – $1594
In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016.
Co-Pay Range
$148 – $1571
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$512 – $721
In the Donut Hole (also called the Coverage Gap) stage, you’ll pay more for your prescriptions. In 2016, the Donut Hole begins once you’ve spent $3,310 in one year.
Co-Pay Range
$71 – $80
In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare will cover most of your drug costs. In 2016, this stage begins once you have spent $4,850.
Want an exact price for your co-pay?

Ways to Save on Palivizumab

Here are some ways that may lower the cost of your Synagis prescription.

Patient Assistance Program
Receive your prescription at no charge if you are eligible.
Patient Assistance Program
Call to get more information on how they can financially assist you with your prescription.
Patient Assistance Program
Call to get more information on how they can financially assist you with your prescription.

Find Your Palivizumab Medicare Co-Pay

Here are average co-pays for some of the most popular Medicare plans. Be sure to add your plan to see your specific co-pay. If a price is shown in red, GoodRx has found discount prices that are lower than your Medicare co-pay.

Average Co-Pay for 1 vial (0.5ml) of Synagis 50mg/0.5ml

Medicare Plan Name Average Co-Pay
AARP MedicareRx Preferred (PDP) $616
AARP MedicareRx Saver Plus (PDP) $388
AARP MedicareRx Walgreens (PDP) $384
Aetna Medicare Rx Saver (PDP) $386
Anthem Blue Cross MedicareRx Plus (PDP) $487
Anthem MediBlue Essential (HMO) $455
CareMore Value Plus (HMO) $850
Cigna-HealthSpring Preferred (HMO) $434
EnvisionRxPlus (PDP) $200
Express Scripts Medicare - Choice (PDP) $392
Express Scripts Medicare - Value (PDP) $377
First Health Part D Value Plus (PDP) $509
Humana Enhanced (PDP) $477
Humana Preferred Rx Plan (PDP) $361
Humana Walmart Rx Plan (PDP) $361
Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost) $524
MedicareBlue Rx Standard (PDP) $398
SilverScript Plus (PDP) $524
Symphonix Value Rx (PDP) $388
TexanPlus Classic (HMO) $1307
Don't see your Medicare plan above?

Find and configure your plan to see exact co-pay prices for your meds.

Palivizumab Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Synagis that may include:

Prior Authorization

Most Medicare plans will require you to obtain their authorization before they will provide coverage for this prescription. You’ll need to contact your plan and they may require you to have your doctor fill out paperwork indicating why you need this prescription. If you do not receive authorization or don’t want to go through this process, you may want to consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

What drug tier is Synagis typically on?

Tier 5

Medicare plans typically list Synagis in Tier 5 of their formulary. Tier 5 drugs are usually non-preferred brand-name drugs. Tier 5 drugs cost more than Tier 1, 2, 3 and 4 drugs.

Does your plan have restrictions?

See discount prices that can save you money when your Medicare plan doesn't work for you.

Medicare prices are provided by the Centers for Medicare and Medicaid Services (CMS). They are accurate as-of January 2017 and the information may be updated. If you encounter any issues, please let us know.
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