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

Fewer drug barriers for advanced cancer patients

Beginning January 1, 2026, Maryland law bars covered health plans from requiring patients to try other drugs first for qualifying prescriptions. This applies to policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after that date. The drug must be FDA-approved to treat stage four advanced metastatic cancer. For direct cancer treatment, its use must match an FDA-approved or National Comprehensive Cancer Network Drugs & Biologics Compendium indication. The protection also covers drugs a treating doctor prescribes for symptoms or side effects from treatment of that cancer. Those uses must follow best practices for the cancer, an associated condition, or treatment side effects, and the plan must cover the drug. Both uses must have support from peer-reviewed medical research. The law removes this try-other-drugs-first requirement without changing plan coverage or patient cost-sharing.