Medical Assistance

ORS 414.772
Limits on use of step therapy


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.


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:


The clinical criteria for each step therapy protocol;


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


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. [Formerly 414.637]


Last accessed
Mar. 11, 2023