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HB 970

Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols

2025 Regular Session Introduced by Tiffany Alston and 37 co-sponsors

Maryland prohibits health insurers from requiring fail-first protocols for insulin prescriptions, enabling immediate patient access to prescribed insulin without prior authorization delays.

Approved by the Governor - Chapter 688
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Bill Summary · HB 970

Legislative bill overview

HB 970 prohibits health insurance plans in Maryland from requiring step therapy or "fail-first" protocols for insulin prescriptions. Step therapy requires patients to try lower-cost medications first before insurance will cover more expensive treatments. This bill eliminates that requirement specifically for insulin, allowing diabetic patients to access their prescribed insulin immediately without prior authorization delays.

Why is this important

Insulin is a life-sustaining medication for diabetics, and delays in access can pose serious health risks including diabetic ketoacidosis and other complications. Step therapy protocols can force patients to use incompatible or less effective insulin formulations, creating medical risks while potentially increasing overall costs through emergency care. The bill addresses a growing national concern about insulin affordability and access barriers, reflecting Maryland's effort to prioritize patient health outcomes over insurance cost-containment procedures.

Potential points of contention

  • Insurance cost implications: Removing step therapy for insulin may increase insurance premiums or reduce insurer flexibility in managing pharmacy costs, potentially affecting overall healthcare expenses
  • Scope limitations: The bill applies only to insulin; other expensive medications remain subject to step therapy, raising questions about consistency in coverage policies and why insulin receives special treatment
  • Definition and implementation concerns: The bill's effectiveness depends on clear regulatory guidance about what constitutes prohibited step therapy and how insurers should handle medically necessary alternatives or generic insulin options

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

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