SB773 requires certain Maryland health insurers, nonprofit health service plans, health maintenance organizations, administrators, carriers, and pharmacy benefits managers to count more forms of third-party and patient-paid assistance toward a person’s deductible, coinsurance, copayment, and annual out-of-pocket maximum. For covered prescription drugs, the bill generally requires that discounts, financial assistance payments, product vouchers, and other out-of-pocket expenses paid by or on behalf of an insured or enrollee be included in cost-sharing calculations, subject to exceptions for certain high-deductible health plans and other federally protected arrangements. It also extends similar rules to broader health care services, including preventive care, and applies to amounts paid on behalf of beneficiaries by another person.
The bill also prohibits insurers, carriers, and pharmacy benefits managers from changing benefit design or otherwise conditioning coverage based on the availability or amount of financial or product assistance for a prescription drug or biological product. In addition, third parties that provide financial assistance must notify the enrollee within seven days of acceptance about the total amount and duration of assistance, and they may not condition assistance on enrollment in a particular health plan except as allowed by federal law. Violations of certain notice requirements are treated as violations of the Maryland Consumer Protection Act.
In practical terms, the bill amends Maryland insurance law to curb accumulator adjustment programs and similar practices that prevent copay assistance from counting toward a patient’s cost-sharing obligations. It applies to policies, contracts, and health benefit plans issued, delivered, or renewed on or after January 1, 2026, and it is scheduled to sunset on July 1, 2029 unless extended by the General Assembly. The law is intended to reduce out-of-pocket burdens for patients who rely on assistance to afford prescription drugs and other covered care.
The overall sentiment reflected in the bill text and voting history is strongly supportive. The preamble frames the measure as a patient-protection and affordability bill, emphasizing access to life-saving medications, medication adherence, and the harms caused by unexpected charges and accumulator programs. The recorded votes were overwhelmingly favorable, including several unanimous third-reading votes and one near-unanimous vote, indicating broad bipartisan agreement.
The main point of contention is the balance between patient affordability and plan design flexibility. The bill limits insurers’ and PBM’s ability to structure benefits around the availability of manufacturer or charitable assistance, while preserving some exceptions for high-deductible health plans and federal law. Another potential issue is the treatment of rebates and the interaction with federal tax rules for health savings accounts, which the bill addresses through carve-outs and technical limitations.
SB773 adds new sections to Maryland’s Insurance Article, creating enforceable requirements for insurers, nonprofit health service plans, health maintenance organizations, administrators, carriers, and pharmacy benefits managers when calculating cost-sharing obligations. It requires inclusion of qualifying third-party assistance in deductible and out-of-pocket calculations, restricts benefit design decisions based on assistance availability, imposes notice duties on assistance providers, and makes certain violations subject to the Consumer Protection Act. The bill also sets rules for how cost-sharing assistance is treated for health care services generally, with exceptions for certain high-deductible health plans and federally governed arrangements, and it applies prospectively to plans renewed or issued on or after January 1, 2026.
The sentiment around SB773 is broadly favorable and patient-centered. The bill’s findings and the unanimous or near-unanimous floor votes suggest strong legislative support for protecting patients from being forced to pay twice when they use copay assistance. The discussion reflected in the bill itself emphasizes affordability, access to medication, and preventing harmful interruptions in treatment, with little evidence of organized opposition in the provided materials.
The primary contention is between consumer protection advocates and health plan/PBM practices that use accumulator adjustment programs or similar mechanisms. Supporters argue that assistance should count toward a patient’s deductible and out-of-pocket maximum because the patient is still receiving help to pay for covered care; opponents would likely argue that requiring such crediting could affect plan costs, premium design, and the use of manufacturer assistance in benefit management. The bill also navigates technical concerns around high-deductible health plans, health savings account eligibility, preventive care, and federal preemption, which are the main areas where implementation questions could arise.