Step therapy protocol definition

Step therapy protocol means a protocol or program that establishes the specific
Step therapy protocol means a protocol or program that establishes a specific sequence in which prescription drugs for a specified medical condition and medically appropriate for a particular covered person are covered under a pharmacy or medical benefit by a health carrier, a health benefit plan, or a utilization review organization, including self-administered drugs and drugs administered by a health care professional.
Step therapy protocol means a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition, whether self−administered or physician−administered, that are medically appropriate for a par- ticular patient are covered under a policy or plan.

Examples of Step therapy protocol in a sentence

  • Step therapy protocol including denials of step therapy exception requests are subject to adverse determination appeal rights as well as an Independent Federal External Review.

  • Step therapy protocol means that an Enrollee may need to use one type of medication before another.

  • Its interventions also focused on stimulating the potential of youth to build a vibrant, productive civil society, and on empowering women as agents of development in their homes and communities.

  • Step therapy protocol means that a member may need to use one type of medication before another.

  • This determination is based40 on a review of the patient's or prescriber's request for an override along with41 supporting rationale and documentation.42 (4) Step therapy protocol.


More Definitions of Step therapy protocol

Step therapy protocol means a protocol that specifies, as a condition of coverage under this Plan, the order in which certain prescription drugs must be used to treat your condition.
Step therapy protocol means a protocol that
Step therapy protocol means a protocol or program that
Step therapy protocol means a protocol or program that (i) establishes the specific sequence in
Step therapy protocol means a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are medically necessary for a particular enrollee and are covered under a pharmacy or medical benefit by a carrier, including self‑administered and physician‑administered drugs.[PL 2019, c. 295, §1 (NEW); RR 2019, c. 1, Pt. A, §26 (RAL).]
Step therapy protocol means a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition, including self-administered drugs and drugs that are administered by a physician[,] , [PHYSICIAN ASSISTANT] [or] advanced practice nurse practitioner are medically appropriate for a particular enrollee and are covered under a health plan.