Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols
Summary
SB 646 amends Maryland insurance law to prohibit insurers, nonprofit health service plans, and health maintenance organizations from using step therapy or fail-first protocols for insulin and certain insulin-related medications used to treat diabetes. The bill expands an existing prohibition that already applies to certain FDA-approved drugs for stage four advanced metastatic cancer, adding insulin, insulin analogs, and other prescription drugs that perform a similar function to insulin, regardless of how they are formulated or administered.
The measure applies to health insurance policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after January 1, 2026. It also applies when prescription drug coverage is provided through a pharmacy benefits manager. In practical terms, the bill requires covered plans to allow patients with type 1, type 2, or gestational diabetes to access insulin-related treatment without first trying alternative drugs or going through insurer-imposed sequencing requirements.
Impact
SB 646 directly changes Section 15-142 of the Insurance Article by adding insulin and insulin analogs to the list of drugs exempt from step therapy or fail-first protocols. It affects insurers, nonprofit health service plans, and HMOs operating in Maryland, including plans that use pharmacy benefits managers for prescription coverage. The bill is intended to reduce barriers to timely diabetes treatment and limit utilization management practices that could delay access to prescribed insulin therapies.
Sentiment
The bill appears to have broad bipartisan support and little visible opposition. It passed the Senate and House unanimously, with recorded votes of 46-0 and 136-0, respectively. The absence of committee transcript discussion suggests the measure was relatively noncontroversial and likely viewed as a patient-access and diabetes-care bill.
Contention
There is no recorded committee debate in the provided materials, and the floor votes were unanimous, so no major points of contention are evident in the legislative history provided. The only likely policy tension is between patient access to insulin and insurer efforts to manage drug utilization and costs through step therapy, but the bill’s unanimous passage indicates that any such concerns did not generate significant opposition in the legislature.