Step Therapy Protocol Exception Program Review Process Sample Clauses

Step Therapy Protocol Exception Program Review Process. You or Your Designated Representative may submit a Standard Step Therapy Protocol Exception Request or an Expedited Step Therapy Protocol Exception Request. We will make a determination concerning a Standard Step Therapy Protocol Exception Request or an appeal of a denial of a Standard Step Therapy Protocol Exception Request within 3 business days from Our receipt of the request or appeal. We will make a determination concerning an Expedited Step Therapy Protocol Exception Request or an appeal of a denial of an Expedited Step Therapy Protocol Exception Request within 1 business day from Our receipt of the request or appeal.  If We grant a Standard Step Therapy Protocol Exception Request or an Expedited Step Therapy Protocol Exception Request, We will notify You, Your Designated Representative and/or Provider of the authorization for coverage of the Prescription Drug that is the subject of the exception request.  If We deny a Standard or Expedited Step Therapy Protocol Exception Request or an appeal of a denial of a Standard or Expedited Step Therapy Protocol Exception Request, We will provide You, Your Designated Representative and/or Provider with notice of the denial, including a detailed written explanation of the reason for the denial and the clinical rationale that supports the denial.
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