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HB 1087

Health Insurance - Step Therapy or Fail-First Protocols - Drugs to Treat Associated Conditions of Advanced Metastatic Cancer

2025 Regular Session Introduced by Tiffany Alston and 22 co-sponsors

Maryland bans insurance step therapy requirements for drugs treating advanced metastatic cancer conditions, allowing immediate access without mandatory cheaper treatment trials first.

Approved by the Governor - Chapter 706
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Bill Summary · HB 1087

Legislative bill overview

HB 1087 prohibits health insurers in Maryland from requiring step therapy (fail-first protocols) before covering drugs used to treat conditions associated with advanced metastatic cancer. Step therapy requires patients to try cheaper or less intensive treatments first before insurance will cover more expensive medications. This bill exempts advanced metastatic cancer patients from that requirement.

Why is this important

Advanced metastatic cancer patients often have limited time and deteriorating health, making treatment delays potentially life-threatening. Removing step therapy barriers allows oncologists to prescribe immediately appropriate medications without insurance-mandated delays, potentially improving survival rates and quality of life for terminal patients. The bill reflects growing concern that bureaucratic treatment protocols are inappropriate for rapidly progressing, life-threatening conditions.

Potential points of contention

  • Insurance costs: Eliminating step therapy requirements may increase insurance premiums and claims costs, potentially affecting all policyholders' rates
  • Definition scope: "Associated conditions" of metastatic cancer is broad and could be interpreted expansively, creating uncertainty about which drugs are actually covered without step therapy
  • Precedent concerns: Carving out exceptions for specific diseases may encourage similar exemptions for other serious conditions, fragmenting insurance policy across diagnoses

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

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