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Bill

SB 975

Health Insurance - Coverage for Specialty Drugs

2025 Regular Session Introduced by Clarence Lam

Maryland law now requires health insurers to expand specialty drug coverage with stricter limits on prior authorization and step therapy requirements for high-cost disease-treating medications.

Approved by the Governor - Chapter 728
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Bill Summary · SB 975

Legislative bill overview

SB 975 requires health insurance plans in Maryland to expand coverage for specialty drugs—typically high-cost medications used to treat complex conditions like cancer, autoimmune diseases, and rare disorders. The bill establishes new standards for how insurers can limit access to these drugs through prior authorization, step therapy, and formulary restrictions.

Why is this important

Specialty drugs represent a growing portion of healthcare costs and can be lifesaving but prohibitively expensive without insurance coverage. Patients with serious conditions often face delays in treatment while insurers review medications, and insurers may require patients to fail cheaper treatments first ("step therapy") before approving specialty drugs—a process that can be medically inappropriate and time-consuming.

Potential points of contention

  • Cost implications: Expanded coverage mandates typically increase insurance premiums; insurers may pass costs to employers and individual policyholders, or reduce profits
  • Prior authorization burden: While the bill likely restricts excessive delays, defining "reasonable" approval timelines and clinical justification standards remains contentious between insurers and patient advocates
  • Formulary flexibility: Insurers argue restrictions on their drug formulary choices limit their ability to negotiate prices and control costs; patient advocates counter that rigid restrictions deny medically necessary treatments

Compiled from official sources — confirm details with the bill’s official record.

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