{"data":{"id":"us-or/ors-414.772","jurisdiction":"us-or","citation":"ORS 414.772","heading":"Limits on use of step therapy.","body":"(1) As used in this section, “step therapy” means a drug protocol in which the cost of a prescribed drug is reimbursed only if the patient has first tried a specified drug or series of drugs.\n      (2) A coordinated care organization that requires step therapy shall make easily accessible to any provider who is reimbursed by the organization, directly or through a risk-bearing entity, to provide health services to members of the organization, clear explanations of:\n      (a) The clinical criteria for each step therapy protocol;\n      (b) The procedure by which a provider may submit to the organization or risk-bearing entity, the provider’s medical rationale for determining that a particular step therapy protocol is not appropriate for a particular patient based on the patient’s medical condition and history; and\n      (c) The documentation, if any, that a provider must submit to the organization or risk-bearing entity for the organization or entity to determine the appropriateness of step therapy for a specific patient.","path":["11 - Juvenile Code, Human Services","34. Human Services; Juvenile Code; Corrections","Chapter 414 — Medical Assistance"],"source_url":"https://www.oregonlegislature.gov/bills_laws/ors/ors414.html","current_through":"2025 Edition","vintage":"","retrieved_at":"2026-09-03T23:50:14Z","sha256":"e0da5290927579367b9838559eec30efb6104426f6fe7d93141423da272b4a78","source_id":"us-or","stale":false,"prev":"us-or/ors-414.771","next":"us-or/ors-414.773"},"notice":"GroundRules: Original legal text. Not legal advice."}