Okla. Stat. tit. 36, § 36-6570.52
This is the official text of Okla. Stat. tit. 36, § 36-6570.52, part of Oklahoma’s Stat. tit. 36, — part of the compiled statutory law of Oklahoma, published by the state as "Stat. tit. 36,." Browse the sections below, each linked to its official government source.
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Adverse determinations to include alternative
Official statutory text
prescription drugs — Qualifications of reviewers.
A utilization review entity shall ensure that all adverse
determinations include alternative prescription drugs covered by the
health plan's formulary and are made by a physician, pharmacist, or
licensed mental health professional. The physician, pharmacist, or
licensed mental health professional shall:
1. Possess a current and valid nonrestricted license in any
United States jurisdiction;
2. Have the appropriate training, knowledge, or expertise to
apply appropriate clinical guidelines to the health care service
being requested; and
3. Make the adverse determination under the clinical direction
provided by the committee or board responsible for developing
policies for drug use, evaluating clinical appropriateness, and
ensuring effective drug use when reviewing prescription drug prior
authorizations to enrollees of Oklahoma. All such medical directors
shall be physicians licensed in any United States jurisdiction.
A utilization review entity shall ensure that all adverse
determinations include alternative prescription drugs covered by the
health plan's formulary and are made by a physician, pharmacist, or
licensed mental health professional. The physician, pharmacist, or
licensed mental health professional shall:
1. Possess a current and valid nonrestricted license in any
United States jurisdiction;
2. Have the appropriate training, knowledge, or expertise to
apply appropriate clinical guidelines to the health care service
being requested; and
3. Make the adverse determination under the clinical direction
provided by the committee or board responsible for developing
policies for drug use, evaluating clinical appropriateness, and
ensuring effective drug use when reviewing prescription drug prior
authorizations to enrollees of Oklahoma. All such medical directors
shall be physicians licensed in any United States jurisdiction.
Status: in_force · Read it on the official government site
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