| Coverage Decisions for Medical Technologies & Procedures |  | |
Implantable Drug Delivery Systems
Coverage decision
Implantable drug delivery systems (infusion pumps or IDDS) including intrathecal and epidural drug infusion pumps, and injectable medications prescribed for administration via the IDDS, are covered for accepted conditions under the following circumstances to:
- Treat pain caused by cancer or other end-stage disease.
- Administer antispasticity drugs when spinal cord injury is an accepted condition.
Implantable drug delivery systems (infusion pumps or IDDS) are not covered for the treatment of chronic non-cancer pain.
Background Policy Information
On August 15th, 2008, the State Health Technology Clinical Committee (HTCC) met at an open public meeting to decide whether state agencies should pay for IDDS for treatment of chronic non-cancer pain. Based on a review of the best available evidence of safety, efficacy and cost-effectiveness, the committee’s determination is that IDDS is not covered for treatment of chronic non-cancer pain. The decision was made final by the HTCC on November 14th, 2008.
Complete information on this HTCC determination is available at: http://www.hta.hca.wa.gov/
All Requests for IDDS Require Prior Authorization
How to request authorization for IDDS for covered conditions
For State Fund Claims
All requests for IDDS are reviewed by L&I’s utilization review (UR) vendor (Qualis).
To request a review for an inpatient hospitalization or an outpatient procedure that requires UR, please contact Qualis Health by one of the following ways:
- Web: Qualis Health’s preferred method of submitting UR requests is via a secure, internet application called iExchange. For more information or to schedule a training session, please go to the Qualis Health web page at http://www.qualishealth.org/cm/washington-landi/web-based_um_request.cfm.
- Phone: (800) 541-2894 (toll free) or (206) 366-3360.
- Fax: (877) 665-0383 (toll free) or (206) 366-3378.
For Crime Victims:
To request a review for an inpatient hospitalization or an outpatient procedure that requires UR, please contact the Crime Victims' Compensation nurse consultant by:
- Phone: (800) 762-3716 (toll free).
- Fax: (360) 902-5333.
Additional information is available at: www.CrimeVictims.Lni.wa.gov
For Self-Insured Claims
For self-insured claims, contact the self-insured employer (SIE) or their third party administrator (TPA) to request authorization. For a list of SIE/TPAs, go to: http://www.lni.wa.gov/ClaimsIns/Insurance/SelfInsure/EmpList/FindEmps/Default.asp
Provider Bulletin 09-01 Implantable Drug Delivery Systems (41 KB PDF).
Health Care Authority's Health Technology Assessment Program site.
For more information:
Contact information.
