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

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.

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 a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition will be covered by a health carrier.

• This determination is based on40 a review of the patient's or prescriber's request for an override along with41 supporting rationale and documentation.42 (4) Step therapy protocol.

• In thissubchapter:(1) "Labeler" and "manufacturer" have the meanings assigned by Section 531.070.(2) "Recipient" means a Medicaid recipient.(3) "Step therapy protocol" means a protocol that requires a recipient to use a prescription drug or sequence of prescription drugs other than the drug that the recipient's physician recommends for the recipient's treatment before a managed care organization provides coverage for the recommended drug.Sec.

• This determination is9 based on a review of the patient's or prescriber's request for an override,10 along with supporting rationale and documentation.11 (4) "Step therapy protocol" means a protocol or program that establishes the12 specific sequence in which prescription drugs for a specified medical13 condition are medically appropriate for a particular patient and are covered14 by an insurer or health plan.15 (5) "Utilization review organization" as defined in G.S. 59-50-61(a)(18).16 "§ 58-50-305.

More Definitions of Step therapy protocol

Step therapy protocol means a protocol or program that establishes a specific sequence in which prescription drugs that are for a specified medical condition and that are consistent with medical or scientific evidence for a particular patient are covered, under either a medical or prescription drug benefit, by a health benefit plan, including both self-administered and physician-administered drugs.

Step therapy protocol means a protocol or program that (i) establishes the specific sequence in

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.

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 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, policy, or program