23 CAR § 149-101. Purpose

(a) This part implements Acts 2021, No. 97, and Acts 2021, No. 645, which amends a definition within Acts 2021, No. 97. (b) Acts 2021, No. 97, requires healthcare insurers to base medication step therapy protocols on appropriate clinical practice guidelines or peer-reviewed data developed by independent experts with knowledge of the condition or conditions under consideration. (c) Acts 2021, No. 97, also ensures that patients have access to a fair, transparent, and independent process for requesting a step therapy protocol exception when the patient's physician deems it appropriate.