MD SB975

Insurers, nonprofit health service plans, and HMOs may not exclude coverage for specialty drugs administered by in-network oncology providers who comply with state dispensing regulations, when the drug is infused, auto-injected, an oral targeted immune modulator, or an oral medication requiring complex dosing or used with infusion/radiation therapy.

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

Reimbursement rates for covered specialty drugs must be agreed upon by the in-network provider and insurer, billed at nonhospital levels, and may not exceed the rate paid to designated specialty pharmacies unless otherwise negotiated.

Pharmacy benefits managers may still require specific pharmacies for specialty drugs, except where the new coverage protections apply to qualifying oncology providers.

Takes effect January 1, 2026, applying to all health insurance policies, contracts, and benefit plans issued, delivered, or renewed on or after that date.