(a) This part applies to a group health benefit plan or health insurance coverage offered in connection with a group health benefit plan that provides coverage for a prescription drug pursuant to a policy that meets the definition of a step therapy protocol, regardless of whether the policy is described as a step therapy protocol, and includes a state or local insurance program, under title 8, chapter 27.

Terms Used In Tennessee Code 56-7-3504

  • Prescription drug: means a drug that under federal or state law is required to be dispensed only pursuant to a prescription order or is restricted to use by individuals authorized by law to prescribe drugs. See Tennessee Code 56-7-3501
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • Step therapy protocol: means a protocol, policy, or program that establishes a specific sequence in which prescription drugs for a specified medical condition, and medically appropriate for a particular patient, are covered by a health carrier or health benefit plan. See Tennessee Code 56-7-3501
(b) This part does not apply to:

(1) The TennCare program provided for in title 71, chapter 5, or a successor program;
(2) The CoverKids Act of 2006, compiled in title 71, chapter 3, part 11; or
(3) The Access Tennessee Act of 2006, compiled in chapter 7, part 29 of this title.
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