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SB 490

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

2026 Regular Session Introduced by Clarence Lam

SB 490 prohibits step therapy protocols for serious mental illness medications in Maryland Medicaid, allowing faster access to prescribed psychiatric drugs without mandatory cheaper-drug trials first.

Hearing 2/17 at 1:00 p.m.
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Bill Summary · SB 490

Legislative bill overview

SB 490 restricts "step therapy" or "fail-first" protocols for prescription drugs treating serious mental illness under Maryland's Medical Assistance Program. The bill limits prior authorization requirements that typically require patients to try cheaper medications first before accessing preferred treatments. This applies specifically to mental health medications covered by the state's Medicaid program.

Why is this important

Mental illness treatment often requires medication adjustments, and forcing patients through ineffective drugs before accessing appropriate treatment can delay care, worsen symptoms, and increase crisis interventions. For individuals experiencing serious mental illness, treatment delays carry real risks including hospitalization, self-harm, and loss of employment or housing. This directly affects vulnerable populations who rely on Medical Assistance coverage.

Potential points of contention

  • Cost implications: Removing step therapy protocols may increase pharmaceutical costs for the state Medicaid program, requiring budget allocation or reduced coverage elsewhere
  • Drug efficacy variation: Mental illness medications work differently for different patients; the bill assumes step therapy delays necessary care, but some argue it prevents unnecessary expensive medications
  • Prior authorization scope: The bill targets serious mental illness specifically; critics may question why similar protections don't extend to other serious conditions, or supporters may argue mental health deserves unique priority

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

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