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Dear Provider,
Effective for claims with dates of service on and after September 1, 2016, Washington Apple Health (Medicaid), administered by the Health Care Authority, will update the Expedited Authorization (EA) list as follows:
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Product
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Code
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Criteria
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Aloxi® Injection (palonosetron)
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129
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Removed
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Diclegis® (doxylamine-pyridoxine)
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129
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Treatment of nausea and vomiting of pregnancy in women who do not respond to conservative management
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granisetron tablet/injection
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127
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Removed
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granisetron tablet/injection
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128
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Removed
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Granisol® (granisetron) solution
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127
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Removed
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Granisol® (granisetron) solution
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128
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Removed
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For more details, see the agency’s Prescription Drug Program Billing Guide page for the current EA list and WPDL.
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