23 CAR § 149-105. Access to clinical review criteria

(a) Upon written request, a healthcare insurer, pharmacy benefit manager, or utilization review organization shall provide all specific written clinical review criteria relating to the particular condition or disease, including clinical review criteria relating to a step therapy protocol override determination. (b) A healthcare insurer, pharmacy benefit manager, or utilization review organization shall make clinical review criteria and other clinical information available on its website and to a healthcare professional on behalf of an insured upon written request.