Maryland Medical Assistance Plan and Health Insurance - Pharmacogenomic Testing - Required Coverage
SB 608 requires the Maryland Medical Assistance Program and most state-regulated health insurers, nonprofit health service plans, and health maintenance organizations to cover certain pharmacogenomic testing. The bill defines pharmacogenomic testing as laboratory genetic testing, including single-gene and multigene panel testing, used to evaluate how a person’s genetic profile may affect medication efficacy, safety, or toxicity.
Coverage is required when the testing is ordered by a treating provider for a patient diagnosed with depression or anxiety, is being used to guide medication selection or dosing, and meets several clinical and evidence-based criteria. Those criteria include that the patient is taking or expected to take a medication with known gene-drug interaction or other evidence-based pharmacogenomic relevance, that the testing is consistent with accepted medical standards, and that the test is covered by Medicare under a national or local coverage determination. The bill also limits prior authorization by requiring a meaningful and timely process, minimal documentation, and allowing requests from either the treating provider or the laboratory.
The bill amends the Health-General and Insurance Articles to add a new coverage mandate for pharmacogenomic testing and extends that mandate to Medicaid managed care organizations beginning July 1, 2027. It also creates enforcement provisions, including monetary penalties, corrective action plans, administrative hearing rights, periodic audits, and a complaint process for patients, prescribers, and laboratories. The bill applies to policies, contracts, and health benefit plans issued, delivered, or renewed on or after January 1, 2027, and a carrier’s failure to cover a required test is treated as an adverse decision.
The available voting history shows strong support for the bill, with the Senate passing it 39-0 on third reading. The committee report was favorable with amendments, suggesting broad agreement on the policy goal while still refining the bill’s language and implementation details. No committee transcript is provided, so the record reflects consensus rather than recorded debate.
The main policy tension in the bill is between expanding access to genetic testing and limiting insurer utilization management. The bill restricts prior authorization by requiring a clear pathway, minimal documentation, and no undue administrative burden, which may be viewed by insurers as limiting their ability to control costs or verify medical necessity. Another point of potential concern is the scope of the mandate—especially the requirement that coverage align with Medicare coverage determinations and the extension of enforcement authority to managed care organizations and carriers—though the unanimous vote suggests these issues did not generate major opposition in the Senate.