Health Insurance - Prescription Drug Formularies and Coverage for Generic Drugs and Biosimilars
SB393 would require Maryland health carriers to make prescription drug formularies easier to find and more transparent on their websites. Carriers would have to post an updated, accurate, and complete formulary in a clearly labeled and publicly accessible location, show tiering and any restrictions, and identify which formulary applies when multiple drug benefit plans are offered. If a formulary changes during the plan year, the carrier would have to update the website within 30 days and clearly note the date and description of the change.
The bill also creates new coverage rules for lower-cost alternatives. If a carrier covers a brand-name reference drug, it must immediately place a qualifying generic drug on the formulary with more favorable cost sharing than the brand drug, and it may not impose prior authorization, step therapy, or other added restrictions that make access harder than for the brand drug. The same framework applies to biosimilars: if a carrier covers a reference biologic, it must make at least one qualifying biosimilar available with more favorable cost sharing, subject to the same limits on utilization management and pharmacy restrictions. These requirements apply to insurers, nonprofit health service plans, and HMOs, including coverage administered through pharmacy benefit managers, but not to managed care organizations.
The bill would amend the Insurance Article by adding new Sections 15–147 and 15–861. It would also define key terms such as formulary, generic drug, biosimilar, reference listed drug, reference product, and wholesale acquisition cost, and it authorizes the Insurance Commissioner to adopt regulations to implement the law. The act would apply to policies, contracts, and health benefit plans issued, delivered, or renewed on or after January 1, 2026.
Because there are no committee transcripts or recorded votes provided, the overall sentiment cannot be measured from debate or roll call. Based on the bill text alone, the measure appears consumer-oriented and aimed at improving transparency and lowering out-of-pocket costs for prescription drugs. The bill’s structure suggests support for broader access to generics and biosimilars while preserving some clinical discretion for formulary developers.
The main points of potential contention are likely to be the mandatory formulary placement rules and the limits on prior authorization, step therapy, and pharmacy restrictions. Health insurers and pharmacy benefit managers may view these provisions as reducing formulary flexibility and cost-management tools, while consumer advocates and patients are likely to favor the bill’s emphasis on transparency and access to lower-cost alternatives. Another possible issue is the bill’s use of wholesale acquisition cost as the trigger for coverage changes, which may be debated as a proxy for actual market value or savings.
SB393 would add new requirements to Maryland’s Insurance Article governing prescription drug formularies and coverage of lower-cost alternatives. It would compel covered carriers to publicly post complete, accessible formularies and to promptly disclose midyear formulary changes, while also requiring qualifying generic drugs and biosimilars to be placed on formularies with more favorable cost sharing than their brand or reference products. The bill would restrict carriers from using prior authorization, step therapy, or pharmacy network barriers to make those lower-cost drugs harder to obtain, and it would apply to most state-regulated health insurance products issued, delivered, or renewed on or after January 1, 2026.
No committee discussion or vote history was provided, so there is no recorded legislative sentiment to summarize from hearings or floor action. On its face, the bill reflects a pro-consumer policy approach focused on transparency, affordability, and access to generics and biosimilars. The absence of recorded opposition or support in the supplied materials means any assessment of political sentiment is limited to the bill’s text and apparent policy goals.
The most likely areas of contention are the bill’s mandatory formulary transparency requirements and its requirement that carriers immediately cover qualifying generics and biosimilars with more favorable cost sharing. Insurers, nonprofit health plans, HMOs, and pharmacy benefit managers may object that the bill limits their ability to manage formularies, negotiate prices, and use utilization controls such as prior authorization and step therapy. Supporters, likely including patient advocates and consumer groups, would probably emphasize reduced drug costs, easier access to information, and faster access to lower-cost alternatives. A secondary point of debate may be the bill’s reliance on wholesale acquisition cost to determine when the coverage mandate applies or ends.