Public Health - Recommendations for Immunizations, Screenings, and Preventive Services - Pharmacist Administration and Required Health Insurance Coverage (The Vax Act)
SB385, the Vax Act, restructures how Maryland identifies and updates recommended immunizations, screenings, and other preventive services. It directs the Secretary of Health to issue recommendations for infants, children, and adults based on generally accepted scientific consensus and clinical guidance, specifically tying those recommendations to major medical organizations and federal public health authorities. For non-immunization preventive services that are not already recommended by HHS or rated A or B by the U.S. Preventive Services Task Force, the bill adds procedural safeguards: a 30-day notice-and-comment period, an analysis from the Maryland Health Care Commission, and a requirement to cite the medical basis for the recommendation.
The bill also expands and clarifies pharmacist vaccination authority. Pharmacists may administer certain vaccines to children as young as 3 years old and, for individuals age 7 and older, may administer vaccines recommended by ACIP, approved or authorized by FDA, or recommended by the Secretary under the new state recommendation process. The bill preserves training, CPR, reporting, and protocol requirements, and continues to require reporting to ImmuNet and notification of prescribers or primary care providers in many cases.
On the insurance side, SB385 updates Maryland’s preventive-services coverage mandates so that carriers must cover, without cost-sharing in most cases, immunizations and other preventive services as updated by the Secretary’s recommendations under the new law. It also amends child wellness coverage requirements to incorporate those updated vaccine recommendations and keeps existing coverage for newborn screening, hearing screening, developmental screening, and other pediatric preventive services. The bill applies to policies and health benefit plans issued, delivered, or renewed on or after January 1, 2027, and takes effect July 1, 2026.
The overall sentiment reflected in the voting history appears supportive, with the bill passing both chambers by substantial margins. The lack of committee transcript excerpts limits insight into detailed debate, but the broad passage suggests general agreement with expanding access to vaccines and preventive care while modernizing the state’s recommendation and coverage framework.
The main points of contention likely center on how much discretion the Secretary of Health should have in setting preventive-service recommendations, the degree to which state coverage rules should track evolving medical guidance, and whether the bill could broaden insurance mandates and pharmacist authority too quickly. The added notice-and-comment and Maryland Health Care Commission review requirements for certain preventive services appear designed to address concerns about transparency, evidence, and oversight.
The bill repeals obsolete pertussis provisions, adds a new Health-General section establishing a state recommendation process for immunizations, screenings, and preventive services, and amends pharmacist and insurance statutes to conform to that process. It expands the legal basis for pharmacist-administered vaccines and requires insurers to cover updated preventive services and childhood immunizations as recommended under the new state framework, affecting pharmacists, carriers, health plans, patients, and the Maryland Insurance Administration.
The bill appears to have been broadly favorable in the legislature, passing the Senate 32-12 and the House 101-31. That voting pattern suggests support for the bill’s public-health and access-to-care goals, though the non-unanimous margins indicate some reservations about expanding state authority over preventive-service recommendations and insurance coverage mandates.
Likely concerns include whether the Secretary of Health should be able to update recommended preventive services beyond existing federal guidance, how much deference should be given to outside medical organizations, and whether the bill could increase insurance costs or regulatory burden. The bill responds to those concerns by requiring notice and comment, an MHCC analysis for certain preventive services, and citation to the medical basis for recommendations, indicating that transparency and evidence standards were important points of debate.