Oklahoma § 36-6570.52 Adverse determinations to include alternative

Oklahoma Statutes

§ 36-6570.52 — Adverse determinations to include alternative

Oklahoma § 36-6570.52

Title 36Insurance

This text of Oklahoma § 36-6570.52 (Adverse determinations to include alternative) is published on Counsel Stack Legal Research, covering Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Okla. Stat. tit. 36, § 36-6570.52 (2026).

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 dr

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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.