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Bill

SB 111

Maryland Medical Assistance Program and Health Insurance - Step Therapy, Fail-First Protocols, and Prior Authorization - Prescription to Treat Serious Mental Illness

2025 Regular Session Introduced by Clarence Lam

SB 111 prohibits step therapy requirements for serious mental illness medications in Maryland Medicaid and health insurance, enabling faster psychiatric drug access without mandatory cheaper alternative trials.

Hearing 1/29 at 1:00 p.m.
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Bill Summary · SB 111

Legislative bill overview

SB 111 restricts "step therapy" or "fail-first" protocols in Maryland's Medical Assistance Program and health insurance plans when prescribing medications for serious mental illness. Step therapy requires patients to try cheaper or alternative treatments before accessing preferred medications. The bill aims to ensure faster access to psychiatric medications deemed medically necessary by providers.

Why is this important

Mental health crises often require urgent medication intervention, and delays caused by step therapy protocols can worsen symptoms, increase emergency room visits, and potentially lead to self-harm. This bill directly affects hundreds of thousands of Marylanders with serious mental illness who rely on Medicaid or regulated health insurance, potentially improving treatment outcomes and reducing crisis situations.

Potential points of contention

  • Healthcare cost implications: Removing step therapy requirements may increase pharmaceutical costs for insurers and the state Medicaid program, potentially raising premiums or requiring budget reallocation
  • Scope and definitions: Disagreement over what constitutes "serious mental illness" and which medications qualify, potentially creating implementation challenges and disputes between providers and insurers
  • Clinical autonomy versus cost controls: Tension between allowing doctors unrestricted prescribing authority and insurers' need to manage costs and ensure evidence-based treatment protocols

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

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