MD SB837

Managed care organizations, insurers, nonprofit health service plans, and HMOs cannot require prior authorization or step therapy/fail-first protocols for prescription drugs reviewed by the Prescription Drug Affordability Board when the Board has not found an affordability challenge, has made a policy recommendation to the General Assembly, or has set an upper payment limit for the drug.

Covered entities cannot limit, restrict, or exclude coverage of prescription drugs on their formulary that have been reviewed by the Board under the same conditions, including prohibitions on reducing maximum coverage, increasing cost sharing, moving drugs to more restrictive tiers, or removing drugs from formularies.

Drugs may only be removed from formularies if the FDA has issued a statement questioning clinical safety or the manufacturer has notified the FDA of a manufacturing discontinuance.

Insurance provisions apply to policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after January 1, 2027.

General provisions take effect July 1, 2026, while insurance-related sections take effect January 1, 2027.