Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit, and Limited Access are all examples of what?

The correct choice is related to the various practices used by health insurance plans to ensure the effective and efficient use of medical resources. Utilization management rules are established to promote appropriate healthcare services while controlling costs and ensuring patient safety.

Step Therapy is a process where patients must try and fail on one or more lower-cost medications before coverage is provided for a more expensive option. This approach not only helps manage treatment costs but also encourages the use of tried-and-true medications first.

Prior Authorization requires healthcare providers to obtain approval from the insurance company before a specific service, treatment, or prescription is covered. This practice helps ensure that the proposed treatment is necessary and considered medically appropriate.

Quantity Limits restrict the amount of medication or number of services that can be dispensed or performed within a certain timeframe. This protection prevents overuse and helps manage overall healthcare costs.

The 7-day limit and Dispensing Limit both serve to manage medication usage effectively. These limits help prevent excess supply that could lead to waste or misuse.

Limited Access indicates that certain medications or treatments are only available under specific conditions, further emphasizing the need for clinical justification for certain types of care.

Together, these practices are designed to optimize patient outcomes while ensuring that healthcare resources are utilized efficiently, reflecting the principles of utilization