Bill > SB1064

This bill establishes comprehensive guidelines for step therapy protocols in health insurance plans, which are sequences of prescription drug coverage for a specific medical condition. The bill defines key terms such as clinical practice guidelines, medical necessity, and step therapy protocols, and requires health insurance providers to use evidence-based, peer-reviewed clinical guidelines when establishing these protocols. If peer-reviewed guidelines are unavailable, providers should default to FDA labeling. The bill mandates that health insurance plans provide a clear and accessible process for healthcare providers and patients to request exceptions to step therapy protocols, which can be granted under specific circumstances, such as potential adverse reactions, expected ineffectiveness, previous treatment failures, or patient stability on a current medication. Providers must respond to exception requests within 72 hours (or 24 hours in urgent cases), and failure to respond means the exception is automatically granted. The bill also includes provisions protecting a healthcare provider's ability to prescribe medically appropriate drugs and adds special considerations for rare disease medications, ensuring that step therapy restrictions align with FDA-approved labeling. The legislation will become effective on November 1, 2025, and applies to health insurance plans delivered, issued, or renewed after that date.

Health and Social Services

http://www.oklegislature.gov/BillInfo.aspx?Bill=sb1064&Session=2600