requires health benefit plans to implement a clear and transparent process for a participant or beneficiary with CRF-COPD to request an exception to step therapy protocol and cover the requested treatment. An exemption may be required when: • Other treatments required under protocol are ineffective; • Delaying effective treatment would cause severe consequences; • Other treatments are likely to cause harm; • Other treatments will prevent a participant from maintaining necessary functional abilities; or • The patient’s disease is life threatening. The health benefit plan will publish requirements and information for requesting an exception to a treatment step therapy protocol to its website. The insurer must respond to exception requests within 72 hours.