Health Insurance - Prescription Drug Formularies and Coverage for Generic Drugs and Biosimilars
Summary
HB529 would require Maryland health insurers, nonprofit health service plans, health maintenance organizations, and certain other carriers to make prescription drug formularies publicly available 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 post timely, clearly labeled updates when formulary changes occur during the plan year.
The bill further directs covered entities 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 lower-cost product is FDA-approved or licensed, marketed, and has a lower wholesale acquisition cost at the time it enters the market. It prohibits prior authorization, step therapy, or other added barriers for those newly added generics or biosimilars, unless their cost rises above the reference product. The bill does not require coverage of brand drugs once a generic or biosimilar is available, and it preserves the role of pharmacy and therapeutics committees in determining medical appropriateness and cost-effectiveness.
Impact
HB529 would add new provisions to the Maryland Insurance Article, creating Section 15-147 on formulary transparency and Section 15-861 on generic drug and biosimilar coverage standards. It would affect insurers, nonprofit health service plans, HMOs, and certain plans using pharmacy benefit managers, while excluding managed care organizations as defined in the Health-General Article. The bill would require carriers to revise website practices, update formularies within 30 days of mid-year changes, and adjust coverage rules so that qualifying generics and biosimilars receive preferred formulary placement and more favorable cost sharing starting with policies renewed or issued on or after January 1, 2026.
Sentiment
No committee transcripts or recorded votes were provided, so there is no direct evidence of debate, amendments, or partisan division in the available materials. Based on the bill text, the measure appears consumer- and cost-savings-oriented, with an emphasis on transparency and lower out-of-pocket prescription costs. The overall framing suggests support for greater access to lower-cost alternatives and clearer information for enrollees.
Contention
The main potential points of contention are likely to be the mandatory formulary placement and cost-sharing rules for generics and biosimilars, especially the prohibition on prior authorization and step therapy for those products once they qualify. Insurers and pharmacy benefit managers may view these requirements as limiting formulary management flexibility, while consumer advocates and patients may support them as reducing barriers to cheaper medications. Another possible issue is the bill’s reliance on wholesale acquisition cost comparisons and the exception allowing carriers to remove preferred treatment if costs change, which could raise implementation and compliance questions.