Commercial Law - Broadband Access - Low-Income Consumer Programs (Maryland Broadband Opportunity and Fairness Act)
HB0382 would limit the use of prior authorization, step therapy, and fail-first protocols for certain prescription drugs used to treat serious mental illness. For the Maryland Medical Assistance Program, beginning July 1, 2025, the bill bars prior authorization for drugs used to treat adult enrollees diagnosed with bipolar disorder, schizophrenia, major depression, post-traumatic stress disorder, or medication-induced movement disorders associated with treatment of serious mental illness. It also prohibits the program from using step therapy or fail-first requirements for those same conditions.
The bill also amends Maryland insurance law to apply similar protections to private insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations. Beginning January 1, 2026, those entities may not impose prior authorization for prescription drugs treating the listed serious mental illnesses in adult insureds or enrollees, and they may not use step therapy or fail-first protocols for those drugs. The bill preserves existing protections for certain cancer treatments and keeps in place a process for step therapy exception requests in other circumstances, including when a drug is contraindicated, ineffective, or the patient is stable on the current medication.
The bill would add new sections to the Health-General and Insurance Articles and expand existing step-therapy rules to specifically protect access to medications for serious mental illness. It would directly affect Medicaid, insurers, nonprofit health service plans, HMOs, managed care organizations, and pharmacy benefit manager arrangements by restricting utilization-management tools for the listed mental health diagnoses. The bill also requires the Department of Health to report Medicaid cost increases through 2031, and it includes a sunset-style abrogation trigger if implementation increases Medicaid costs by more than $2 million in a year.
The bill’s structure suggests generally favorable treatment of access to mental health medications, with a policy emphasis on reducing administrative barriers for patients and prescribers. No committee transcript or vote record was provided, so there is no direct evidence of debate or recorded support/opposition in the supplied materials. The bill’s inclusion of a cost-monitoring and abrogation mechanism indicates an attempt to balance access concerns with fiscal oversight.
The main likely point of contention is the tradeoff between patient access to psychiatric medications and payer control over costs and utilization management. Supporters would likely emphasize that prior authorization and step therapy can delay effective treatment for serious mental illness, while opponents may argue that removing these tools could increase spending and reduce plan flexibility. The bill’s Medicaid cost cap and automatic abrogation provision appear designed to address that fiscal concern, especially for the Medical Assistance Program.