Maryland House Bill HB382

Maryland 2025 Regular Session

• Introduced: 1/16/25
• Refer: 1/16/25

Caption

Maryland Medical Assistance Program and Health Insurance - Step Therapy, Fail-First Protocols, and Prior Authorization - Prescription to Treat Serious Mental Illness

Impact

If enacted, this bill will alter how health plans manage and authorize prescription medications for serious mental illnesses. Starting July 1, 2025, insurers and managed care organizations will not be allowed to impose step therapy or fail-first protocols for the specified conditions. The intent behind this approach is to reduce barriers to treatment and ensure that patients can receive prescribed medications without unnecessary delays or prerequisites. However, the bill includes provisions for reporting cost increases related to its implementation, underscoring the need to balance patient access with potential financial impacts on the Maryland Medical Assistance Program.

Summary

House Bill 382 seeks to implement significant changes in the Maryland Medical Assistance Program and health insurance coverage regarding prescription drugs for serious mental illnesses. Specifically, the bill prohibits the application of prior authorization requirements, step therapy protocols, and fail-first protocols for certain medications used to treat conditions such as bipolar disorder, schizophrenia, major depression, and post-traumatic stress disorder (PTSD). These changes aim to enhance access to necessary medications for individuals who are enrolled in the Maryland Medical Assistance Program and certain health insurance plans.

Contention

The legislation carries potential points of contention concerning cost management and the efficacy of treatment protocols. Critics worry that the absence of step therapy could lead to higher overall costs for the Maryland Medical Assistance Program if patients opt for more expensive medications without first attempting other treatments. Supporters argue that prioritizing patient choice and clinician recommendations is essential for effective treatment, especially in mental health, where timely access to the right medications is crucial. The requirement for bi-annual reporting on costs adds a layer of accountability but may not alleviate concerns regarding the financial implications of the bill.