Expedited Authorization (EA) List Updates

HCA Apple Health Medicaid

 

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:

Product

Code

Criteria

Aloxi® Injection (palonosetron)

129

Removed

Diclegis® (doxylamine-pyridoxine)

129

Treatment of nausea and vomiting of pregnancy in women who do not respond to conservative management

granisetron tablet/injection

127

 

Removed

granisetron tablet/injection

128

Removed

Granisol® (granisetron) solution

127

 

Removed

Granisol® (granisetron) solution

128

Removed

 

For more details, see the agency’s Prescription Drug Program Billing Guide page for the current EA list and WPDL.