Okla. Stat. tit. 36, § 36-6570.52: Adverse determinations to include alternative
Where this section sits in the code
- OK Code
- Title 36
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.
Collected 2026-09-14T18:32:36Z. Source file · JSON