Maryland 2025 Regular Session

Maryland House Bill HB970 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3	3		EXPLANATION: CAPITALS INDICATE MATTER ADDE D TO EXISTING LAW .
4	4		[Brackets] indicate matter deleted from existing law.
5	5		Underlining indicates amendments to bill.
6	6		Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7	7		amendment.
8		-	Italics indicate opposite chamber/conference committee amendments.
9	8		hb0970
10	9
11	10		HOUSE BILL 970
12		-	J5, J4 (5lr2851)
13		-	ENROLLED BILL
14		-	— Health and Government Operations/Finance —
15		-	Introduced by Delegates Woods, Alston, Bagnall, Bhandari, Chisholm, Davis,
16		-	Fisher, Ghrist, Guzzone, Harris, Harrison, Kaufman, Kerr, J. Long, Lopez,
17		-	Martinez, McCaskill, M. Morgan, Patterson, Roberts, Rosenberg, Schmidt,
18		-	Simmons, Szeliga, Taveras, Taylor, Terrasa, and Wilkins Wilkins, Cullison,
19		-	Hill, Hutchinson, S. Johnson, Kaiser, Kipke, Pena –Melnyk, Reilly, Ross,
	11	+	J5, J4 5lr2851
	12	+	CF SB 646
	13	+	By: Delegates Woods, Alston, Bagnall, Bhandari, Chisholm, Davis, Fisher, Ghrist,
	14	+	Guzzone, Harris, Harrison, Kaufman, Kerr, J. Long, Lopez, Martinez,
	15	+	McCaskill, M. Morgan, Patterson, Roberts, Rosenberg, Schmidt, Simmons,
	16	+	Szeliga, Taveras, Taylor, Terrasa, and Wilkins Wilkins, Cullison, Hill,
	17	+	Hutchinson, S. Johnson, Kaiser, Kipke, Pena –Melnyk, Reilly, Ross,
20	18		White Holland, and Woorman
21		-
22		-	Read and Examined by Proofreaders:
23		-
24		-	_______________________________________________
25		-	Proofreader.
26		-	_______________________________________________
27		-	Proofreader.
28		-
29		-	Sealed with the Great Seal and presented to the Governor, for his approval this
30		-
31		-	_______ day of _______________ at ________________________ o’clock, ________M.
32		-
33		-	______________________________________________
34		-	Speaker.
	19	+	Introduced and read first time: January 31, 2025
	20	+	Assigned to: Health and Government Operations
	21	+	Committee Report: Favorable with amendments
	22	+	House action: Adopted
	23	+	Read second time: February 27, 2025
35	24
36	25		CHAPTER ______
37	26
38	27		AN ACT concerning 1
39	28
40	29		Health Insurance – Insulin – Prohibition on Step Therapy or Fail–First 2
41	30		Protocols 3
42	31
43	32		FOR the purpose of prohibiting certain insurers, nonprofit health service plans, and health 4
44	33		maintenance organizations from imposing a step therapy or fail–first protocol on 5
45		-	insulin or an insulin analog or certain other similar medications used to treat an 6
46		-	insured’s or enrollee’s diabetes; and generally relating to use of step therapy and 7
47		-	fail–first protocols. 8
	34	+	insulin or certain other similar medications used to treat an insured’s or enrollee’s 6
	35	+	diabetes; and generally relating to use of step therapy and fail–first protocols. 7
48	36
49		-	BY repealing and reenacting, without amendments, 9 2 HOUSE BILL 970
	37	+	BY repealing and reenacting, without amendments, 8
	38	+	Article – Insurance 9
	39	+	Section 15–142(a)(1) and (4) and (b) 10
	40	+	Annotated Code of Maryland 11
	41	+	(2017 Replacement Volume and 2024 Supplement) 12
	42	+
	43	+	BY repealing and reenacting, with amendments, 13
	44	+	Article – Insurance 14
	45	+	Section 15–142(e) 15
	46	+	Annotated Code of Maryland 16
	47	+	(2017 Replacement Volume and 2024 Supplement) 17
	48	+	2 HOUSE BILL 970
50	49
51	50
52		-	Article – Insurance 1
53		-	Section 15–142(a)(1) and (4) and (b) 2
54		-	Annotated Code of Maryland 3
55		-	(2017 Replacement Volume and 2024 Supplement) 4
	51	+	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
	52	+	That the Laws of Maryland read as follows: 2
56	53
57		-	BY repealing and reenacting, with amendments, 5
58		-	Article – Insurance 6
59		-	Section 15–142(e) 7
60		-	Annotated Code of Maryland 8
61		-	(2017 Replacement Volume and 2024 Supplement) 9
	54	+	Article – Insurance 3
62	55
63		-	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 10
64		-	That the Laws of Maryland read as follows: 11
	56	+	15–142. 4
65	57
66		-	~~Article – Insurance 12~~
	58	+	(a) (1) In this section the following words have the meanings indicated. 5
67	59
68		-	15–142. 13
	60	+	(4) (i) “Step therapy or fail–first protocol” means a protocol established 6
	61	+	by an insurer, a nonprofit health service plan, or a health maintenance organization that 7
	62	+	requires a prescription drug or sequence of prescription drugs to be used by an insured or 8
	63	+	an enrollee before a prescription drug ordered by a prescriber for the insured or the enrollee 9
	64	+	is covered. 10
69	65
70		-	(a) (1) In this section the following words have the meanings indicated. 14
	66	+	(ii) “Step therapy or fail–first protocol” includes a protocol that 11
	67	+	meets the definition under subparagraph (i) of this paragraph regardless of the name, label, 12
	68	+	or terminology used by the insurer, nonprofit health service plan, or health maintenance 13
	69	+	organization to identify the protocol. 14
71	70
72		-	(4) (i) “Step therapy or fail–first protocol” means a protocol established 15
73		-	by an insurer, a nonprofit health service plan, or a health maintenance organization that 16
74		-	requires a prescription drug or sequence of prescription drugs to be used by an insured or 17
75		-	an enrollee before a prescription drug ordered by a prescriber for the insured or the enrollee 18
76		-	is covered. 19
	71	+	(b) (1) This section applies to: 15
77	72
78		-	(ii) “Step therapy or fail–first protocol” includes a protocol that 20
79		-	meets the definition under subparagraph (i) of this paragraph regardless of the name, label, 21
80		-	or terminology used by the insurer, nonprofit health service plan, or health maintenance 22
81		-	organization to identify the protocol. 23
	73	+	(i) insurers and nonprofit health service plans that provide hospital, 16
	74	+	medical, or surgical benefits to individuals or groups on an expense–incurred basis under 17
	75	+	health insurance policies or contracts that are issued or delivered in the State; and 18
82	76
83		-	(b) (1) This section applies to: 24
	77	+	(ii) health maintenance organizations that provide hospital, 19
	78	+	medical, or surgical benefits to individuals or groups under contracts that are issued or 20
	79	+	delivered in the State. 21
84	80
85		-	(i) ~~insurers and~~ nonprofit health service ~~plans that provide hospital~~, 25
86		-	~~medical, or surgical~~ benefits ~~to individuals or groups on an expense–incurred basis under 26~~
87		-	~~health insurance policies or contracts that are issued or delivered in~~ the ~~State; and 27~~
	81	+	(2) An insurer, a nonprofit health service plan, or a health maintenance 22
	82	+	organization that provides coverage for prescription drugs through a pharmacy benefits 23
	83	+	manager is subject to the requirements of this section. 24
88	84
89		-	(ii) ~~health maintenance organizations that provide hosp ital,~~ 28
90		-	~~medical,~~ or ~~surgical benefits to individuals or groups under contracts that are issued or 29~~
91		-	~~delivered in the State.~~ 30
	85	+	(e) An entity subject to this section may not impose a step therapy or fail–first 25
	86	+	protocol on an insured or an enrollee for a prescription drug approved by the U.S. Food and 26
	87	+	Drug Administration if: 27
92	88
93		-	(2) An insurer, a nonprofit health service plan, or a health maintenance 31
94		-	organization that provides coverage for prescription drugs through a pharmacy benefits 32
95		-	manager is subject to the requirements of this section. 33
96		-	HOUSE BILL 970 3
	89	+	(1) (I) the prescription drug is used to treat the insured’s or enrollee’s 28
	90	+	stage four advanced metastatic cancer; and 29
	91	+
	92	+	[(2)] (II) use of the prescription drug is: 30
	93	+
	94	+	[(i)] 1. consistent with the U.S. Food and Drug 31
	95	+	Administration–approved indication or the National Comprehensive Cancer Network 32
	96	+	Drugs & Biologics Compendium indication for the treatment of stage four advanced 33
	97	+	metastatic cancer; and 34 HOUSE BILL 970 3
97	98
98	99
99		-	(e) An entity subject to this section may not impose a step therapy or fail–first 1
100		-	protocol on an insured or an enrollee for a prescription drug approved by the U.S. Food and 2
101		-	Drug Administration if: 3
102	100
103		-	(1) (I) the prescription drug is used to treat the insured’s or enrollee’s 4
104		-	stage four advanced metastatic cancer; and 5
	101	+	[(ii)] 2. supported by peer–reviewed medical literature; OR 1
105	102
106		-	[(2)~~] (II) use of~~ the prescription ~~drug~~ is: 6
	103	+	(2) THE PRESCRIPTION DRU G IS: 2
107	104
108		-	[(i)] 1. consistent with the U.S. Food and Drug 7
109		-	Administration–approved indication or the National Comprehensive Cancer Network 8
110		-	Drugs & Biologics Compendium indication for the treatment of stage four advanced 9
111		-	metastatic cancer; and 10
	105	+	(I) INSULIN USED TO TREAT THE IN SURED’S OR ENROLLEE ’S 3
	106	+	TYPE 1, TYPE 2, OR GESTATIONAL DIABE TES; AND 4
112	107
113		-	[(ii)~~] 2~~. ~~supported by peer–reviewed medical literature~~; OR 11
	108	+	(II) 1. INSULIN; OR 5
114	109
115		-	(2) THE PRESCRIPTION DRUG IS: 12
	110	+	2. AN INSULIN ANALOG OR OTHER PRESCRIPTION D RUG 6
	111	+	THAT PERFORMS A SIMI LAR FUNCTION TO INSU LIN, REGARDLESS OF THE 7
	112	+	ACTIVATION PERIOD , WHETHER THE SOLUTION IS MIXED BEFORE OR A FTER 8
	113	+	DISPENSING, OR WHETHER THE DRUG IS ADMINISTERED BY I NJECTION OR 9
	114	+	INHALATION. 10
116	115
117		-	(I) INSULIN OR AN INSULIN ANALOG USED TO TREAT THE 13
118		-	INSURED’S OR ENROLLEE ’S TYPE 1, TYPE 2, OR GESTATIONAL DIABE TES; AND 14
	116	+	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 11
	117	+	policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 12
	118	+	after January 1, 2026. 13
119	119
120		-	(II) 1. INSULIN; OR 15
	120	+	SECTION 3. AND BE IT FURTHER ENACTED, That this A ct shall take effect 14
	121	+	January 1, 2026. 15
121	122
122		-	2. AN INSULIN ANALOG OR OTHER PRESCRIPTION D RUG 16
123		-	THAT PERFORMS A SIMI LAR FUNCTION TO INSULIN , REGARDLESS OF THE 17
124		-	ACTIVATION PERIOD , WHETHER THE SOLUTION IS MIXED BEFORE OR A FTER 18
125		-	DISPENSING, OR WHETHER THE DRUG IS ADMINISTERED BY I NJECTION OR 19
126		-	INHALATION. 20
127	123
128		-	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 21
129		-	policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 22
130		-	after January 1, 2026. 23
131	124
132		-	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 24
133		-	January 1, 2026. 25
	125	+
	126	+	Approved:
	127	+	________________________________________________________________________________
	128	+	Governor.
	129	+	________________________________________________________________________________
	130	+	Speaker of the House of Delegates.
	131	+	________________________________________________________________________________
	132	+	President of the Senate.