An accident insurance policy or any other insurance contract providing reimbursement for the cost of prescription drugs, hospital expenses, health care services and medical expenses, equipment and supplies.
“Step therapy” means a drug protocol in which a health care coverage plan will reimburse the cost of a prescribed drug only if the patient has first tried a specified drug or series of drugs.
A health care coverage plan that requires step therapy shall make easily accessible to prescribing practitioners, clear explanations of:
The clinical criteria for each step therapy protocol;
The procedure by which a practitioner may submit to the plan the practitioner’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 practitioner must submit to the plan for the plan to determine the appropriateness of step therapy for a specific patient. [2014 c.55 §4]Note: 743B.602 (Step therapy) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.