Health Care Facilities - Surgical Smoke - Smoke Evacuation Systems
Summary
HB1087 amends Maryland’s insurance law governing step therapy, also known as fail-first protocols, for prescription drugs covered by insurers, nonprofit health service plans, and health maintenance organizations. The bill creates a new exception for drugs prescribed by a treating physician to address symptoms of, or side effects from treatment of, stage four advanced metastatic cancer, when the provider determines that leaving the condition untreated would negatively affect the patient’s health.
Under the bill, a covered drug may not be subjected to step therapy if it is consistent with best practices for advanced metastatic cancer or related conditions, is supported by peer-reviewed medical literature, and is otherwise covered under the policy or contract. The bill also preserves the existing rule for FDA-approved drugs used to treat stage four advanced metastatic cancer itself, while expanding protection to supportive care medications tied to cancer symptoms and treatment side effects. The law applies to policies, contracts, and health benefit plans issued, delivered, or renewed on or after January 1, 2026.
Impact
The bill amends Section 15-142 of the Insurance Article to limit when carriers may require patients to try lower-cost or preferred drugs before covering a physician-prescribed medication. It specifically restricts step therapy for certain cancer-related drugs and supportive treatments, affecting insurers, nonprofit health service plans, HMOs, and pharmacy benefit manager arrangements that provide prescription drug coverage in Maryland. The change is intended to reduce delays in access to medically necessary cancer care and supportive therapies for patients with advanced metastatic cancer.
Sentiment
The available voting history suggests broad bipartisan support for the bill, with overwhelming passage in both chambers and only one recorded dissenting vote in the House. The lack of committee transcript material limits direct insight into floor debate, but the strong vote totals indicate the measure was generally viewed favorably as a patient-access and cancer-care bill. Overall, the sentiment appears supportive and noncontroversial in the legislature.
Contention
The main policy issue is the balance between insurer utilization management tools and physician-directed cancer treatment. Supporters likely viewed the bill as necessary to prevent delays in care for patients with advanced metastatic cancer and to ensure access to symptom- and side-effect-management drugs. Any opposition would likely have centered on concerns about limiting step therapy, increasing costs, or reducing insurer control over coverage decisions, but the recorded votes show little organized resistance.