MD SB111

Prohibits the Maryland Medical Assistance Program, insurers, nonprofit health service plans, and HMOs from requiring prior authorization, step therapy, or fail-first protocols for prescription drugs treating serious mental illnesses in adults, including bipolar disorder, schizophrenia, major depression, PTSD, and medication-induced movement disorders

Step therapy and fail-first protocol restrictions for Medicaid enrollees take effect July 1, 2025; private insurance requirements apply to policies issued or renewed on or after January 1, 2026

Requires the Maryland Department of Health to report annually (January 31, 2027 through 2031) on any cost increases to the Medical Assistance Program resulting from implementation

Includes an automatic termination provision: if the Department of Legislative Services determines the Medicaid provisions caused costs to increase by more than $2,000,000 from the preceding fiscal year, Section 1 (Medicaid provisions) is automatically abrogated

Applies to managed care organizations and entities providing prescription drug coverage through pharmacy benefits managers