Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols
Summary
HB970 amends Maryland’s insurance law to prohibit certain health insurers, nonprofit health service plans, and health maintenance organizations from applying step therapy or fail-first protocols to insulin and related diabetes medications. The bill covers insulin, insulin analogs, and other prescription drugs that perform a similar function to insulin when used to treat type 1, type 2, or gestational diabetes. In practical terms, a covered patient cannot be required to try a different drug first before the prescribed insulin-related medication will be covered.
The bill builds on existing Maryland law that already limits step therapy for certain FDA-approved drugs used to treat stage four advanced metastatic cancer. HB970 adds a separate diabetes-specific protection to the same insurance statute, expanding the circumstances in which insurers may not force patients through prior treatment steps before coverage begins. The law applies to policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after January 1, 2026.
Impact
HB970 directly changes Insurance Article §15-142 by adding insulin and insulin analogs to the list of drugs exempt from step therapy or fail-first requirements. It affects insurers, nonprofit health service plans, and HMOs that provide hospital, medical, surgical, or prescription drug coverage in Maryland, including coverage administered through pharmacy benefits managers. The practical effect is to limit utilization management tools for diabetes treatment and ensure faster access to prescribed insulin-related therapies for covered enrollees.
Sentiment
The bill appears to have been strongly supported and noncontroversial in the legislature. It passed the House and Senate with unanimous recorded votes in the available history, including 136-0, 133-0, and 46-0 third-reading votes. The lack of recorded opposition and the straightforward patient-access purpose suggest broad bipartisan agreement.
Contention
No committee testimony or transcript excerpts were provided, and the voting record shows no recorded dissent. Based on the bill text, any potential point of contention would likely center on the balance between patient access and insurer cost-management tools, since step therapy is a common utilization control. However, the available record does not show organized opposition, and the final votes indicate little to no legislative controversy.