As used in this part:

(1) “Health benefit plan” has the same meaning as defined in § 56-61-102;
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Terms Used In Tennessee Code 56-7-3501

  • 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
(2) “Health carrier” has the same meaning as defined in § 56-61-102;
(3) “Healthcare provider” has the same meaning as defined in § 56-61-102;
(4) “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);
(5) “Pharmaceutical sample” means a unit of a prescription drug that is not intended to be sold;
(6) “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;
(7) “Required prescription drug” means a medication that is required as part of a step therapy protocol;
(8) “Step therapy exception” occurs when a step therapy protocol is overridden in favor of immediate coverage of the healthcare provider’s selected prescription drug;
(9) “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
(10) “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.
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