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Ohio Rev. Code Ann. § 3901.831

Implementation of step therapy protocol

Effective: April 5, 2019; Latest Legislation: Senate Bill 265 - 132nd General Assembly

(A) If a health plan issuer or a utilization review organization implements a step therapy protocol, that protocol shall be implemented via clinical review criteria that are based on clinical practice guidelines or medical or scientific evidence.

(B) When establishing a step therapy protocol, a health plan issuer and a utilization review organization shall also take into account the needs of atypical patient populations and diagnoses when establishing clinical review criteria.

(C) This section shall not be construed as requiring either a health plan issuer or the state to set up a new entity to develop clinical review criteria for step therapy protocols.

Official source: Ohio Laws & Administrative Rules (Legislative Service Commission). Reproduced from public-domain Ohio statutes; confirm against the official source for the current text. Not legal advice.