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 drug utilization management prior authorization protocol or program that establishes the specific sequence in which prescription drugs are covered by a health carrier for a medical condition.
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.