EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0989*
SENATE BILL 989
J5, J4 4lr2478
CF HB 939
By: Senators Lam, Muse, Brooks, and M. Washington
Introduced and read first time: February 2, 2024
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Health Insurance – Epinephrine Injectors – Limits on Cost Sharing 2
(Epinephrine Cost Reduction Act of 2024) 3
FOR the purpose of requiring certain insurers, nonprofit health service plans, and health 4
maintenance organizations to limit the amount a covered individual is required to 5
pay in copayments, coinsurance, and deductibles for a covered prescription 6
epinephrine injector; and generally relating to health insurance coverage for 7
prescription epinephrine injectors. 8
BY adding to 9
Article – Insurance 10
Section 15–861 11
Annotated Code of Maryland 12
(2017 Replacement Volume and 2023 Supplement) 13
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 14
That the Laws of Maryland read as follows: 15
Article – Insurance 16
15–861. 17
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 18
INDICATED. 19
(2) (I) “EPINEPHRINE INJECTOR ” MEANS A PORTABLE , 20
DISPOSABLE DRUG DELI VERY DEVICE THAT CON TAINS A PREMEASURED SINGLE 21
DOSE OF EPINEPHRINE THAT IS USED TO TREA T ANAPHYLAXIS IN AN EMERGENCY 22
SITUATION. 23
2 SENATE BILL 989
(II) “EPINEPHRINE INJECTOR ” INCLUDES: 1
1. AN AUTO–INJECTOR APPROVED BY THE U.S. FOOD 2
AND DRUG ADMINISTRATION FOR TH E ADMINISTRATION OF EPINEPHRINE ; AND 3
2. A PRE–FILLED SYRINGE APPRO VED BY THE U.S. 4
FOOD AND DRUG ADMINISTRATION FOR TH E ADMINISTRATION OF EPINEPHRINE 5
THAT CONTAINS A PRE –MEASURED DOSE OF EPI NEPHRINE THAT IS EQU IVALENT TO 6
THE DOSAGES USED IN AN AUTO–INJECTOR. 7
(B) (1) THIS SECTION APPLIES TO: 8
(I) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 9
PROVIDE COVERAGE FOR PRESCRIPTION DRUGS A ND DEVICES UNDER IND IVIDUAL, 10
GROUP, OR BLANKET HEALTH IN SURANCE POLICIES OR CONTRACTS THAT ARE 11
DELIVERED IN THE STATE; AND 12
(II) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 13
COVERAGE FOR PRESCRI PTION DRUGS AND DEVI CES TO INDIVIDUALS O R GROUPS 14
UNDER CONTRACTS THAT ARE ISSUED OR DELIVE RED IN THE STATE. 15
(2) AN INSURER, A NONPROFIT HEALTH SERVICE PLAN, OR A HEALTH 16
MAINTENANCE ORGANIZA TION THAT PROVIDES C OVERAGE FOR PRESCRIP TION 17
DRUGS AND DEVICES TH ROUGH A PHARMACY BEN EFITS MANAGER IS SUB JECT TO 18
THE REQUIREMENTS OF THIS SECTION. 19
(C) AN ENTITY SUBJECT TO THIS SECTION SHALL L IMIT THE TOTAL AMOUNT 20
A COVERED INDIVIDUAL IS REQUIRED TO PAY I N COPAYMENTS , COINSURANCE , AND 21
DEDUCTIBLES FOR A TW IN–PACK OF MEDICALLY NE CESSARY PRESCRIPTION 22
EPINEPHRINE INJECTOR S TO NOT MORE THAN $60, REGARDLESS OF THE TY PE OF 23
EPINEPHRINE INJECTOR NEEDED TO F ILL THE COVERED INDI VIDUAL’S 24
PRESCRIPTION . 25
(D) AN ENTITY SUBJECT TO THIS SECTION MAY SET THE AMOUNT A 26
COVERED INDIVIDUAL I S REQUIRED TO PAY AT AN AMOUNT THAT IS LE SS THAN THE 27
PAYMENT AMOUNT LIMIT UNDER SUBSECTION (C) OF THIS SECTION. 28
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 29
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 30
after January 1, 2025. 31
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 32
January 1, 2025. 33