MD SB646

Prohibits insurers, nonprofit health service plans, and health maintenance organizations from imposing step therapy or fail-first protocols on insulin and insulin analogs used to treat Type 1, Type 2, or gestational diabetes

Covers all forms of insulin regardless of activation period, whether mixed before or after dispensing, or whether administered by injection or inhalation

Applies to all health insurance policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after January 1, 2026

Extends existing step therapy protections that already applied to stage four advanced metastatic cancer treatments to now include diabetes medications

Signed by Governor Wes Moore on May 20, 2025