The medicaid agency reimburses the kidney center for EPO therapy when:

1. (1) Administered in the kidney center to a client:

   1. (a) With a hematocrit less than 33 percent or a hemoglobin less than 11 when therapy is initiated;
   2. (b) Continuing EPO therapy with a hematocrit between 30 and 36 percent; or

   3. (c) Medical justification documented in the client's record is required for hematocrits more than 36 or hemoglobins more than 12. Medical justification includes:

      1. (i) Documentation that the dose is being titrated downward to bring a patient's hematocrit back within target range; or
      2. (ii) Documentation that it is medically necessary for the client to have a target hematocrit more than 36 percent.

2. (2) Provided to a home dialysis client:

   1. (a) Under the same hematocrit and hemoglobin guidelines as stated in (1)(a) and (b) of this section; and
   2. (b) When permitted by Washington board of pharmacy rules. (Refer to WAC 246-945-090 Home dialysis program—Legend drugs.)

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-09-050, s 182-540-200, filed 4/10/25, effective 5/11/25; 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.]