Senate Bill No. 1064 amends Section 7310 of Title 63 of the Oklahoma Statutes to establish guidelines for health insurance plans that utilize step therapy protocols. The bill mandates that health carriers and utilization review organizations must use recognized, evidence-based, and peer-reviewed clinical practice guidelines when creating step therapy protocols, and if such guidelines are unavailable, decisions should default to the FDA label as the authoritative reference. Additionally, the bill requires health insurance providers to offer a clear process for patients and healthcare providers to request exceptions to step therapy protocols, ensuring that exceptions are granted under specific conditions, such as contraindications or previous adverse reactions to the required prescription drug.

The bill also stipulates that health insurance providers must respond to requests for step therapy exceptions within 72 hours, or within 24 hours in exigent circumstances, with failure to respond resulting in automatic approval of the exception. Furthermore, if a prescription drug subject to step therapy is FDA-approved for a rare disease and no clinical guidelines are available, the restrictions imposed by the step therapy protocol cannot be more stringent than the FDA-required labeling conditions. The Oklahoma Insurance Department and the Oklahoma Health Care Authority are tasked with adopting necessary rules to implement this act, which is set to take effect on November 1, 2025.