Pennsylvania Statutes Title 40 P.S. Insurance § 991.2156. Step therapy considerations

(i) Contraindications, including adverse reactions.

(ii) Clinical effectiveness or ineffectiveness of each required prerequisite prescription drug or therapy.

(iii) Past clinical outcome of each required prerequisite prescription drug or therapy.

(iv) The expected clinical outcomes of the requested prescription drug prescribed by the covered person's or enrollee's health care provider.

(v) For covered persons or enrollees who previously received health care coverage from another entity, whether the covered person or enrollee has already satisfied a step therapy protocol with their previous insurer or MA or CHIP managed care plan that required trials of prescription drugs from each of the classes that are required by the current insurer's or MA or CHIP managed care plan's step therapy protocol.