Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

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: What we're working on | Washington State Health Care Authority  

All Requests for IDDS Require Prior Authorization

All requests for IDDS are reviewed by L&I’s utilization review (UR) vendor (Comagine).