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Bill

HB 382

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 Andre Johnson and 4 co-sponsors

Maryland bill eliminates mandatory step-therapy drug protocols for serious mental illness, enabling immediate access to prescribed psychiatric medications without requiring cheaper alternatives first.

Hearing 1/30 at 1:00 p.m.
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Bill Summary · HB 382

Legislative bill overview

HB 382 restricts "step therapy" or "fail-first" protocols in Maryland's Medical Assistance Program and health insurance plans when treating serious mental illness. Step therapy requires patients to try cheaper medications first before insurers approve more expensive alternatives. This bill would eliminate that requirement specifically for serious mental health conditions, allowing direct access to prescribed psychiatric medications.

Why is this important

Mental illness often requires specific medication combinations tailored to individual patient biology and medical history. Forced delays while trying less effective medications first can worsen symptoms, increase hospitalization risks, and delay necessary treatment. This directly affects access to care for vulnerable populations relying on state medical assistance and insured individuals with serious mental health diagnoses.

Potential points of contention

  • Cost implications: Removing step therapy requirements may increase insurance and state program costs by allowing immediate access to higher-cost medications without trying lower-cost alternatives first
  • Definition disputes: "Serious mental illness" requires precise legal definition—disagreement over which conditions qualify could create implementation challenges and potential coverage gaps
  • Insurance industry impact: Health insurers may argue stepped protocols help control costs and that clinical evidence supports trying standard treatments before specialty medications
  • Medical necessity balance: Debate over whether psychiatrists' clinical judgment should override insurers' cost-control measures versus insurers' legitimate role in managing pharmaceutical expenses

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

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