State Law

Ohio Revised Code-Title XXXIX-Chapter 3901. Superintendent of Insurance

08/17/2023 Ohio Section 3901.831

Implementation of step therapy protocol

U.R. Criteria

(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.