Health insurance; establishing guidelines for step therapy protocol. Effective date,

SB 1064 requires health insurance plans in Oklahoma to use evidence-based clinical guidelines when creating step therapy protocols (which dictate the order of medications covered for a condition). It mandates that insurers provide a clear, accessible process for patients and doctors to request exceptions to these protocols, including a 72-hour response deadline (24 hours for emergencies), with exceptions automatically approved if deadlines are missed. The bill specifies five medical justifications for granting exceptions, such as drug ineffectiveness, adverse reactions, or prior successful use of a medication. This directly affects insurers, healthcare providers, and patients seeking coverage for specific prescription drugs under step therapy.