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Current as of January 01, 2023 | Updated by Findlaw Staff
(1) As used in this section, “step therapy” means a drug protocol in which the cost of a prescribed drug is reimbursed only if the patient has first tried a specified drug or series of drugs.
(2) A coordinated care organization that requires step therapy shall make easily accessible to any provider who is reimbursed by the organization, directly or through a risk-bearing entity, to provide health services to members of the organization, clear explanations of:
(a) The clinical criteria for each step therapy protocol;
(b) The procedure by which a provider may submit to the organization or risk-bearing entity, the provider's medical rationale for determining that a particular step therapy protocol is not appropriate for a particular patient based on the patient's medical condition and history; and
(c) The documentation, if any, that a provider must submit to the organization or risk-bearing entity for the organization or entity to determine the appropriateness of step therapy for a specific patient.
Cite this article: FindLaw.com - Oregon Revised Statutes Human Services; Juvenile Code; Corrections § 414.637 - last updated January 01, 2023 | https://codes.findlaw.com/or/title-34-human-services-juvenile-code-corrections/or-rev-st-sect-414-637/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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