MD HB1243

Insurers, nonprofit health service plans, and HMOs cannot exclude coverage for specialty drugs administered or dispensed by in-network oncology providers who comply with state regulations for specialty drug handling

Covered specialty drugs include infused medications, auto-injected drugs, oral targeted immune modulators, and oral medications requiring complex dosing or used with infusion/radiation therapies

Reimbursement rates for covered specialty drugs must be agreed upon by the provider and insurer, billed at nonhospital rates, and cannot exceed the rate paid to designated specialty pharmacies unless otherwise negotiated

Specialty drugs are defined as prescription medications costing $600+ for a 30-day supply, prescribed for complex/chronic/rare conditions, not typically stocked at retail pharmacies, and requiring special handling or enhanced patient support (excludes diabetes, HIV, and AIDS medications)

Effective January 1, 2026, applying to all policies issued, delivered, or renewed in Maryland on or after that date