OK SB1064

Requires health insurance plans using step therapy protocols to base decisions on recognized, evidence-based peer-reviewed clinical practice guidelines when available, or default to FDA labeling when guidelines are unavailable.

Mandates health insurance plans provide healthcare providers and patients with clear, convenient, and readily accessible processes to request step therapy exceptions, including a process on the insurer's website.

Establishes that step therapy exceptions must be granted when a provider's justification demonstrates the required drug is contraindicated, expected to be ineffective, previously failed, not in the patient's best interest, or if the patient is stable on an alternative drug.

Requires health insurance plans to respond to step therapy exception requests within 72 hours (or 24 hours for exigent circumstances), with deemed approval if no timely response is provided.

Applies special protections for rare disease drugs approved by the FDA under Section 360bb of Title 21 U.S. Code, limiting step therapy restrictions to FDA labeling requirements when no clinical practice guidelines are available.

Effective date: November 1, 2025.