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The 2018 Washington State Legislature directed the Washington State Institute for Public Policy (WSIPP) to conduct evidence reviews on step therapy and step therapy exceptions and to summarize step therapy exceptions codified in other states. One goal of the assignment is to determine whether this type of prescription drug utilization management practice has an effect on health outcomes. In this report, we describe the results of our evidence reviews on step therapy and step therapy exceptions and describe the limitations of the research evidence. We also summarize the step therapy exceptions codified in other states and describe Washington’s codified step therapy exception.