The highway travels north along North 1500 East (Clear Lakes Road), skirting the east side of the city and crossing the tracks of the Eastern Idaho Railroad, and travels through a rural area while descending a 6 percent grade near Clear Springs.

Near the McHan Reservoir, the highway reaches the summit of Johnson Hill, located at an elevation of 5,635 feet (1,718 m), and begins its descent into the Camas Prairie.

After descending over 500 feet (150 m), it turns northwest and reaches its northern terminus with US 20, four miles (6.4 km) east of Fairfield.

[2] SH-46 originally terminated at the I-84 interchange in Wendell, while the remaining 15 miles (24.1 km) of the Rex Leland Highway to Buhl was under local ownership.

[3] In 1997, the Idaho Transportation Department (ITD) agreed to take over maintenance and ownership of the highway once right of way for a wider roadway was acquired and prepared.