Sec. 69-10.14. Prior approval requests for experimental treatment

Latest version.

(a) A request for prior approval for experimental treatment must be accompanied by a letter from the treating physician explaining why the enrollee needs the experimental treatment being requested and documentation that either no standard treatment has been effective in treating the enrollee or there is no standard treatment available to treat the enrollee’s condition, injury or impairment.
(b) All requests for prior approval for experimental treatment involving the use of an experimental medication will be reviewed by the fund administrator’s pharmacy benefits manager.

                    
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