(1) As used in this part:(1) “Associated conditions” means the symptoms or side effects associated with stage 4 advanced metastatic cancer, metastatic blood cancer, or treatment of such cancers and which, in the judgment of the healthcare provider, further jeopardizes the health of a patient if left untreated;(2) “Biosimilar” means a biological product that is licensed under 42 U.S.C. § 262(k) and that is not listed as “discontinued” in the federal food and drug administration's database of licensed biological products, also known as the “Purple Book”;(3) “Health benefit plan” has the same meaning as defined in § 56-61-102;(4) “Health carrier” has the same meaning as defined in § 56-61-102;(5) “Healthcare provider” has the same meaning as defined in § 56-61-102;(6) “Interchangeable biological product” means a biological product licensed by the federal food and drug administration and determined to meet the safety standards for determining interchangeability pursuant to 42 U.S.C. § 262(k)(4);(7) “Pharmaceutical sample” means a unit of a prescription drug that is not intended to be sold;(8) “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;(9) “Required prescription drug” means a medication that is required as part of a step therapy protocol;(10) “Stage 4 advanced metastatic cancer” means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the body;(11) “Step therapy exception” occurs when a step therapy protocol is overridden in favor of immediate coverage of the healthcare provider's selected prescription drug;(12) “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; and(13) “Utilization review organization” means an entity that conducts utilization review, as defined in § 56-6-703, other than a health carrier or health benefit plan performing utilization review for its own health plans.
(1) “Associated conditions” means the symptoms or side effects associated with stage 4 advanced metastatic cancer, metastatic blood cancer, or treatment of such cancers and which, in the judgment of the healthcare provider, further jeopardizes the health of a patient if left untreated;
(2) “Biosimilar” means a biological product that is licensed under 42 U.S.C. § 262(k) and that is not listed as “discontinued” in the federal food and drug administration's database of licensed biological products, also known as the “Purple Book”;
(3) “Health benefit plan” has the same meaning as defined in § 56-61-102;
(4) “Health carrier” has the same meaning as defined in § 56-61-102;
(5) “Healthcare provider” has the same meaning as defined in § 56-61-102;
(6) “Interchangeable biological product” means a biological product licensed by the federal food and drug administration and determined to meet the safety standards for determining interchangeability pursuant to 42 U.S.C. § 262(k)(4);
(7) “Pharmaceutical sample” means a unit of a prescription drug that is not intended to be sold;
(8) “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;
(9) “Required prescription drug” means a medication that is required as part of a step therapy protocol;
(10) “Stage 4 advanced metastatic cancer” means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the body;
(11) “Step therapy exception” occurs when a step therapy protocol is overridden in favor of immediate coverage of the healthcare provider's selected prescription drug;
(12) “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; and
(13) “Utilization review organization” means an entity that conducts utilization review, as defined in § 56-6-703, other than a health carrier or health benefit plan performing utilization review for its own health plans.