MD HB1461

Expands existing specialty drug coverage protections to include rheumatologic conditions, in addition to the current oncology coverage requirements under Maryland Insurance Code § 15-847.2

Prohibits insurers, nonprofit health service plans, and HMOs from excluding coverage for specialty drugs dispensed by in-network rheumatology providers who comply with state regulations for administering and dispensing specialty drugs

Applies to auto-injected medications, oral targeted immune modulators, and oral medications requiring complex dosing or used with infusion therapies for rheumatologic conditions

Reimbursement rates must be agreed upon by the provider and insurer, billed at nonhospital level of care, and may not exceed rates paid to designated specialty pharmacies unless otherwise negotiated

Takes effect January 1, 2027, applying to all policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after that date