Considering the RSV shot - Page 2 - Mothering Forums

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#31 of 50 Old 09-25-2008, 10:58 AM
 
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Audrey is in preapproval right now for them. The nurse said she should be approved.
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#32 of 50 Old 09-26-2008, 03:12 AM
 
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DS was a 33 weeker, and he got the shots. I did my research and didn't think twice about doing it.

One thing to know is that this is an extremely painful injection. DS usually didn't act "right" until about day 3 after the injection. This was one of the few times we used Tylenol.

"In the depth of winter, I finally learned that within me there lay an invincible summer"
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#33 of 50 Old 09-26-2008, 10:47 AM
 
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My twins were 30 weekers born in March 06. We passed on the shots and they have never had anything more then a runny nose while teething.
They are unvaxed too.

single mommy to identical twin girls (3/06) Non-traditional mama just : through life.
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#34 of 50 Old 09-28-2008, 01:37 AM
 
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This will be the 4th year for my 3.5 year old to get the synagis.. Im 100% PRO synagis.. Im anti vaxing now but this is one I will not mess around with.

My son is very at risk for it for a lot of reasons. He got it last year and it was horrible. He didnt do well at all.
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#35 of 50 Old 09-28-2008, 01:42 AM
 
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Sorry.. I should have read the replies before I posted..




Quote:
Originally Posted by polishprinsezz View Post
do you breastfeed? my breastfed daughter had it at 3 months but didnt get hospitalized. my cousins baby who was 6 weeks older also had it at the same time. he was formula fed and had to stay in the hospital a week. breastfeeding does help lesson the severity but i would consider the shot for this season if baby is a preemie going into daycare and isnt drinking breastmilk full time. you probably wont have to do the shot next season as baby will be bigger and stronger. here's to a healthy baby all winter long!
Re the breasmilk.. My 3.5 year old mention in the prior past is still 100% breastfed and even so he got RSV .....

Quote:
Originally Posted by irangel View Post
That makes sense. Our NICU only gave Syngais to the most at risk kids in September and all others started in October. My daughter was the only one to get a September shot because she was trached and vented having significant problems. She came home in October and got her shot that month out patient.

We havent been in the NICU during RSV season but have been in the hospital during it for a few years.. Around here the chronic kids (like the trach, vented kids) get it one month earlier than the others. We have always gotten it earlier than the others too because of the trach and vent and other crap.


Last year it was pretty tough to qualify because Alo (my middle child) was 2.5 at the time.. The cutoff age is normally 2 unless there are other medical issues.. Even with him being on a ventilator, oxygen, trach, etc he still had trouble qualifying.. This year we are going to have a really tough time qualifying but we are fighting like crazy for it.
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#36 of 50 Old 09-28-2008, 09:16 AM
 
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We vax, but are cautious with ones not required by our school system (flu shot, etc). However this year, I think the benefits outweight the risks. Our 6 weeks out 28 weeker will be home in a week or so and we're planning on getting him the RSV shots and are seriously considering flu vax for everyone in the house (we have three older kids too, two of whom are in school). Our pediatrician has only the mercury free flu shots. We asked.
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#37 of 50 Old 09-28-2008, 01:33 PM
 
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My dd received Synagis for 2 seasons and I'd do it again for her.

She breastfed exclusively for her first 8 mos and we stayed pretty close to home during the first 2 seasons.

As far as when different NICUs start giving the Synagis shots- ours gave them a few days before they sent the babies home if it was during the season. I live in a seasonal area so the season starts at slightly different times each year. It is based on how many confirmed cases of RSV are reported to the CDC for our area.

I do know that a few states are considered to be "in season" almost all year round. Those were CA and FL when I last checked. They have a very high proportion of tourists and always seem to have a few active cases of RSV at any given moment. The babies in those states are eligible for Synagis year round (depending on the insurance co's of course).

You can check the CDC website for current RSV trends, it is organized by region, state, ect-
CDC RSV Maps
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#38 of 50 Old 09-29-2008, 01:32 PM
 
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We just talked to the doctor about the RSV shots a few days ago in fact. The nurse that will be giving Hayden the shot said the qualifying factors for a baby to get the shots are some of the following.


Factors:
1. Age
* Gestational Age/Premature birth - 35 weeks of gestation or earlier, but only with additional risk factors
* Chronologic age at the start of the RSV season
* Younger than 24 months of age - Infants born at 28 weeks of gestation or earlier may benefit from prophylaxis up to 12 months of age; infants born at 29 to 32 weeks of gestation may benefit most from prophylaxis up to 6 months of age. Children over this age may have to meet other requirements in order to receive approval.

2. Weight
* Birth weight
* Percentile on the growth chart
* Underlying conditions causing low weight

3. Health Factors
* History of severe and/or chronic recent respiratory illness - Children with chronic lung disease (CLD) who have required medical therapy for their CLD within 6 months before the anticipated RSV season
* History of recent respiratory distress
* Health conditions dependent upon respiratory therapy or medications: eg - oxygen, albuterol, steroids, trachiotomy, suction, and/or other respiratory equipment dependency
* Health conditions that show substantial risk of future respiratory distress
- Chronic lung disease (CLD)
- Pulmonary Hypertension
- Asymptomatic acyanotic congenital heart disease (CHD): eg - patent ductus arteriosus or ventricular septal defect
* Immunocompromised children - immune system deficiencies: eg - severe combined immunodeficiency or severe acquired immunodeficiency syndrome

4. Costs and Other Factors
* Risk of hospitalization cost compared to prophylaxis cost
* Underlying conditions that predispose to respiratory complications (eg, neurologic disease in very low birth weight infants, lung development)
* Number of young siblings
* Child care center attendance
* Exposure to tobacco smoke in the home
* Anticipated cardiac surgery
* Distance to and availability of hospital care for severe respiratory illness
* Fragility of the medication itself - must be used within 20 minutes of mixing, must be transported and stored under strictest conditions, availability to health care provider, etc.
* Doctor recommendation and/or Letter of Medical Necessity.

Most, if not all, insurance companies require all children that receive Synagis to have precedence of respiratory illness, risk of future distress, and respiratory therapy dependency of some kind before they will even consider the other factors. It is not enough to simply be of the right age, weight, and have a gestational period of less than 35 weeks. RSV is dangerous to all children, especially premature babies, but it seems that the insurance companies want to reserve it for those who have chronic respiratory issues and are at future risk of distress.






We start the RSV shots in October, and Hayden will get one each month until April, it's expensive and we are lucky our insurance covers it.... the letter i got from the hospital it's over $1200.00 per veil so 8400 bucks at a minimum. But it's worth it for us because my hubby's niece has had RSV many times so from now until probably late spring, she will not be allowed near the baby.

Actually probably most of this winter we will keep him away from anyone that doesn't need to be near him.

Hope this helps you determine if your lil one qualifies... lets hope the insurance companies stop being such a pain about covering these shots.

The boys get vax'ed for only things required to go to school. We did the flu shot one year and my older son got so sick, never again.
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#39 of 50 Old 09-29-2008, 06:21 PM
 
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Well Its either 1,200 a month for approx 4-6 months or 1,500 - 3,000 per day for a 2 or 3 week PICU stay if the baby does get RSV... I think more insurances would pay for it rathen than wanting to rsik a larger bill.. but thats not always the case... I could give you many stories of the silly things insurances do.

FWIW You can appeal the decision if you are denied.
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#40 of 50 Old 09-29-2008, 06:59 PM
 
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Quote:
Originally Posted by Khourtniey View Post
Well Its either 1,200 a month for approx 4-6 months or 1,500 - 3,000 per day for a 2 or 3 week PICU stay if the baby does get RSV... I think more insurances would pay for it rathen than wanting to rsik a larger bill.. but thats not always the case... I could give you many stories of the silly things insurances do.
I don't want to pick bones, but I found this article interesting on the subject.


RSV therapy not cost-effective for infants

Last Updated: 2004-12-13 16:24:44 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Treatment with Synagis (palivizumab), a type of antibody therapy, is not a cost effective way of preventing infection with respiratory syncytial virus (RSV) in high-risk infants, according to two new reports published in the medical journal Pediatrics.

The American Academy of Pediatrics recommends Synagis for infants and young children born prematurely with at least two other risk factors and for those with congenital heart disease.

Drs. Laura E. Young and William T. Mahle, at Emory University School of Medicine in Atlanta, conducted a cost analysis to determine if the protection offered by the drug was worth the cost.

The total cost of Synagis during one RSV season was estimated to be $6,160 per child. Considering the cost of Synagis versus hospitalization, the authors estimate a net loss of more than $20 million per 5,000 patients.

"The cost of administering the (Synagis) regimen to prevent one day of hospitalization was $4,600 -- nearly three times the cost of one day in the hospital," they note.

"Given the large number of congenital heart disease patients who might be considered candidates for (anti-RSV therapy) routine use of Synagis in young children with... congenital heart disease needs to be evaluated further," Young and William advise.

Dr. Steven Wegner and colleagues at the University of North Carolina in Chapel Hill conducted a study of patients born prematurely who were enrolled in the North Carolina Medicaid program. They analyzed costs during the 2002 to 2003 RSV season for 185 infants administered Synagis and 182 who were not.

During that season, 5 patients in the Synagis group and 12 in the comparison group were hospitalized -- not much of a difference from a statistical standpoint. There were no deaths in either group.

Despite no real differences in outcome, the seasonal costs per person were much higher in the Synagis group: $5,117 versus $371 in the comparison group.

Wegner's group points out that in light of ballooning Medicaid costs, many states have resorted to cutting enrollment and eliminating services.

"When Medicaid programs are faced with decisions concerning cutting enrollment versus reducing drug use that is not cost-effective, we feel certain that the choice is obvious," they note.

SOURCE: Pediatrics, December 2004.




This came from this post.
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#41 of 50 Old 09-30-2008, 11:58 PM
 
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Quote:
Originally Posted by Khourtniey View Post
Well Its either 1,200 a month for approx 4-6 months or 1,500 - 3,000 per day for a 2 or 3 week PICU stay if the baby does get RSV... I think more insurances would pay for it rathen than wanting to rsik a larger bill.. but thats not always the case... I could give you many stories of the silly things insurances do.

FWIW You can appeal the decision if you are denied.
We just got the final pay out for our 10 day hospital stay for RSV (2 days were in the IMC/PICU). It cost $65,000 and that was without any sort of advanced respiratory support!
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#42 of 50 Old 09-30-2008, 11:59 PM
 
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Quote:
Originally Posted by Khourtniey View Post
Last year it was pretty tough to qualify because Alo (my middle child) was 2.5 at the time.. The cutoff age is normally 2 unless there are other medical issues.. Even with him being on a ventilator, oxygen, trach, etc he still had trouble qualifying.. This year we are going to have a really tough time qualifying but we are fighting like crazy for it.
We're working to get approval for Dakota's 3rd full season of Synagis. She was denied off the bat due to age (2.5yrs) but we're appealing. She has significant lung damage, is oxygen dependent, requires a vibrating vest, breathing treatments q4hrs and even the simple cold puts her in the hospital. I am hopeful, based on what the pulmo has said, that we'll be approved but still worried we may not be. It's great to hear others have fought and won!
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#43 of 50 Old 10-01-2008, 12:18 AM
 
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Quote:
Originally Posted by irangel View Post
We're working to get approval for Dakota's 3rd full season of Synagis. She was denied off the bat due to age (2.5yrs) but we're appealing. She has significant lung damage, is oxygen dependent, requires a vibrating vest, breathing treatments q4hrs and even the simple cold puts her in the hospital. I am hopeful, based on what the pulmo has said, that we'll be approved but still worried we may not be. It's great to hear others have fought and won!
Last year we were denied because of the age... They didnt even look at the medical problems. Just automatically said he is too old.. But he had trach, vent oxygen, IPV, etc.. The year prior to that he did not have his trach and stuff but they denied him because he "should be off of the oxygen by now according to his age blah blah blah".. Mind you, he was still on oxygen and in the hospital. He is now 3.5 and this will be his 4th year if we get it. He still has his trach, vent, oxygen and stuff

It just makes no sense that they wont even look at the medical reasons .. I guess they just think most parents wont even fight it.. or at least hope they wont.
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#44 of 50 Old 10-18-2008, 04:02 PM
 
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We did not vax, but we did do the RSV shot (Synagis) from about October through June for both of them. It did its job and I was extremely grateful for that as it was a terrible season where we lived. Insurance was not a problem, thank goodness - it was around $2000/month.
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#45 of 50 Old 10-18-2008, 04:12 PM
 
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we just got a denial letter for the synagis. she will be 6m 2 days too soon.
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#46 of 50 Old 10-18-2008, 04:15 PM
 
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I'm having problems with my insurance too.

Ds was born at 35 weeks, was vented 3 different times, had a week and half NICU stay and has already been hospitalized again after coming home, he is 5 weeks old.

He recieved his first Synagis shot the day he discharged from the NICU. His next shot is due Monday and my insurance won't cover it.

I have 2 older children in school, another in daycare, and he will be starting daycare by the first of November.

My 3 and 5 year old were hospitalized at the same time last October AND the October the year before. My 5 year old had Pnuemonia both times and my 3 year old had Pnuemonia and RSV both times.

His immune system is very weak and has other medical problems.

AND THEY STILL WON'T APPROVE IT!!!!!!!!!!!!!!!!!!!!!!!!!
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#47 of 50 Old 10-18-2008, 07:19 PM
 
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Quote:
Originally Posted by mommy2maya View Post
we just got a denial letter for the synagis. she will be 6m 2 days too soon.
It's not uncommon to get initial denial letters but often times an appeal gets the job done. Persistence is key with insurance companies.
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#48 of 50 Old 10-18-2008, 07:20 PM
 
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Quote:
Originally Posted by justme&my3+1 View Post
I'm having problems with my insurance too.

Ds was born at 35 weeks, was vented 3 different times, had a week and half NICU stay and has already been hospitalized again after coming home, he is 5 weeks old.

He recieved his first Synagis shot the day he discharged from the NICU. His next shot is due Monday and my insurance won't cover it.

I have 2 older children in school, another in daycare, and he will be starting daycare by the first of November.

My 3 and 5 year old were hospitalized at the same time last October AND the October the year before. My 5 year old had Pnuemonia both times and my 3 year old had Pnuemonia and RSV both times.

His immune system is very weak and has other medical problems.

AND THEY STILL WON'T APPROVE IT!!!!!!!!!!!!!!!!!!!!!!!!!
That's so so so frustrating! I would definitely push your doctor to appeal the decision.
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#49 of 50 Old 10-21-2008, 02:03 PM
 
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Hopefully Numax will be out soon. That is the new drug to replace Synagis. I think it's made it through phase 3 clinical trials now. The cost per shot would probably be comparable but it will only need to be given every 60 days. Overall the cost would be half of what it is now so maybe it would be easier to get insurance companies to pay it. I also think it is supposed to be for a larger market (elderly and high risk patients).

My 32 week twins got the shots through December. We moved and the new insurance company denied them because they were over 6 months old. I didn't even think of trying to appeal. Fortunately they didn't get sick the rest of the winter.

mama to six ('98, '00, '04, '04, '06, '08)
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#50 of 50 Old 10-22-2008, 06:29 PM
 
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our DD was also born at 35wks, so this is something we wil be considering also, even tho we don't vax.. but we still have soem more reaserch to do
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