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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 thirty-three percent or a hemoglobin less than eleven when therapy is initiated;
(b) Continuing EPO therapy with a hematocrit between thirty and thirty-six percent; or
(c) Medical justification documented in the client's record is required for hematocrits more than thirty-six or hemoglobins more than twelve. 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 thirty-six 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 246-905-020 Home dialysis program—Legend drugs.)
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 15-14-040, § 182-540-200, filed 6/24/15, effective 7/25/15. WSR 11-14-075, recodified as § 182-540-200, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520, 74.09.522, and 42 C.F.R. 405.2101. WSR 03-21-039, § 388-540-200, filed 10/8/03, effective 11/8/03.]
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