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Ama Policy

Medicare Advantage Step Therapy D-320.984

09/02/2022

Step Therapy Override

Ama Policy

Step Therapy D-320.981

01/03/2022

Step Therapy Override

Ama Policy

Step Therapy H-320.937

08/30/2022

Step Therapy

Step Therapy Override

Ama Policy

Third Party Payer Quantity Limits H-185.942

08/29/2023

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, Step Therapy Override, U.R. Criteria

Ama Policy

Prior Authorization Requirements for Post-Operative Opioids: H-95.919

10/14/2019

ERISA-Med. Nec. Decisions-Deadlines, Med. Adv.-Med. Nec. Appeals-Deadlines, Step Therapy Override

Federal Law

Title 42-Chapter IV-Subchapter B-Part 423. Subpart M—Grievances, Coverage Determinations, Redeterminations, and Reconsiderations

11/18/2024 42 CFR 423.578

Exceptions process

Step Therapy Override

Ama Policy

Eliminate Fail First Policy in Addiction Treatment H-320.941

07/30/2019

Step Therapy Override

Ama Policy

The Impact of Pharmacy Benefit Managers on Patients and Physicians D-110.987

07/30/2019

Step Therapy Override

Ama Policy

Medicare Part B Competitive Acquisition Program (CAP) H-110.983

07/30/2019

Step Therapy Override

State Law

Ariz. Rev. Statutes-Title 20. Insurance-Chapter 30-Article 1. General Provisions

07/28/2023 Arizona Sections 20-3651 through 20-3654

Definitions; Applicability; Clinical review criteria; Exceptions; process

Step Therapy Override