; appeals and external reviews; and trends, if any, in exception requests by medical specialty or medical condition. . (c) Clerical amendment The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1001 et seq. ) is amended by inserting after the item relating to section 713 the following new items: Sec. 713A. Required exceptions process for medication step therapy protocols. . (d) Effective date (1) In general The amendment made by subsection (b) applies with respect to plan years beginning with the first plan year that begins at least 6 months after the date of the enactment of this Act. (2) Regulations Not later than 6 months after the date of the enactment of this Act, the Secretary of Labor shall issue final regulations, through notice and comment rulemaking, to implement the provisions of section 713A of the Employee Retirement Income Security Act of 1974, as added by subsection (b).