2025 Session
Last amended: 2006 session
§ 62M.072 — Use of Evidence-based Standards
Plain-Language Summary
Establishes requirements for utilization review of step therapy protocols used by health plan companies.
62M.072 USE OF EVIDENCE-BASED STANDARDS.
If no independently developed evidence-based standards exist for a particular treatment, testing, or imaging procedure, then an insurer or utilization review organization shall not deny coverage of the treatment, testing, or imaging based solely on the grounds that the treatment, testing, or imaging does not meet an evidence-based standard. This section does not prohibit an insurer or utilization review organization from denying coverage for services that are investigational, experimental, or not medically necessary.
History:
History: History:
2006 c 255 s 32
Practical Notes
If your health plan requires you to try cheaper medications first (step therapy), this section governs how those requirements are reviewed and applied.