WAC 182-540-200. Epoetin alpha (EPO) therapy

The medicaid agency reimburses the kidney center for EPO therapy when: (1) Administered in the kidney center to a client: (a) With a hematocrit less than 33 percent or a hemoglobin less than 11 when therapy is initiated; (b) Continuing EPO therapy with a hematocrit between 30 and 36 percent; or (c) Medical justification documented in the client's record is required for hematocrits more than 36 or hemoglobins more than 12. Medical justification includes: (i) Documentation that the dose is being titrated downward to bring a patient's hematocrit back within target range; or (ii) Documentation that it is medically necessary for the client to have a target hematocrit more than 36 percent. (2) Provided to a home dialysis client: (a) Under the same hematocrit and hemoglobin guidelines as stated in (1)(a) and (b) of this section; and (b) When permitted by Washington board of pharmacy rules. (Refer to WAC 246-945-090 Home dialysis program—Legend drugs.)