Code Revision - Health - Maryland Medical Assistance Program
HB 529 would require health carriers in Maryland to post their prescription drug formularies on their websites in an updated, accurate, and easily accessible format. The bill also requires carriers to identify which formulary applies to which plan, show tiering and restrictions, and update the website within 30 days when a formulary changes during the plan year, with the date and description of the change clearly displayed. In addition, carriers may not require a user to create an account or enter a policy number just to view the formulary.
The bill further directs insurers, nonprofit health service plans, and health maintenance organizations that cover prescription drugs to place certain lower-cost generic drugs and biosimilars on formularies with more favorable cost sharing than the corresponding brand or reference product, when the generic or biosimilar is FDA-approved or licensed and has a lower wholesale acquisition cost at the time it is first marketed. Once added, those drugs generally cannot be subject to prior authorization, step therapy, or other more burdensome access restrictions than the brand or reference product. The bill does not require coverage of a brand drug after a generic or biosimilar becomes available, and it allows carriers to remove coverage if their clinical experts determine the drug is no longer medically appropriate or cost-effective.
HB 529 would add new provisions to the Insurance Article, creating Sections 15-147 and 15-861. It would impose website transparency requirements on carriers and establish a new coverage framework favoring lower-cost generic drugs and biosimilars in certain health benefit plans, including plans administered through pharmacy benefits managers. The bill would apply to policies, contracts, and health benefit plans issued, delivered, or renewed on or after January 1, 2026, and authorizes the Insurance Commissioner to adopt implementing regulations.
The bill appears generally consumer-oriented and pro-access, with its structure aimed at improving transparency and lowering out-of-pocket prescription drug costs. The available record does not include committee testimony or recorded votes, but the bill’s design suggests support for broader access to generics and biosimilars and for clearer formulary information for enrollees and the public. Its last recorded action indicates it passed the House.
The main points of potential contention are the mandates on carriers to change formulary placement and cost sharing, and the limits on utilization management tools such as prior authorization and step therapy for newly added generics and biosimilars. Carriers and pharmacy benefit managers may object to the operational and pricing constraints, while supporters are likely to emphasize transparency and affordability. Another possible issue is the bill’s reliance on wholesale acquisition cost comparisons and the exception allowing carriers to revert if costs change or if clinical experts deem a drug not medically appropriate or cost-effective.