Requires group health plans and health insurance issuers that use medication step therapy to provide a clear, fast exception process so patients and prescribers can request alternate medications. The rule sets specific grounds for granting exceptions, strict time limits for routine and urgent reviews, requires at least one year of coverage when an exception is approved, and mandates publication and use of standardized forms and reporting.

Plans must make the exception process publicly available (paper and electronic), use standardized forms, respond faster in urgent cases, keep beneficiaries on an approved medication for at least one year, and submit required reports and comply with regulatory deadlines set by the statute.