All Roll Calls
Yes: 183 • No: 2
MarylandHB 12432025 Regular SessionHouseWALLET
Health Insurance - Coverage for Specialty Drugs
Sponsored By: Steve Johnson (Democratic)
Signed by Governor
Health - InsuranceDrugs -see also- Cannabis; ControlDangSubst; Pharm; etc.Health Insurance -see also- ACA; HMOs; MCOsHealth Maintenance Organizations -see also- Manage Care OrgsHealth Occupations -see also- (specific health occupations)Health Services Cost Review CommissionMedical TreatmentsNonprofit OrganizationsPrices -see also- Consumer Price IndexReimbursement RatesRules and Regulations
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
More specialty-drug coverage for Maryland patients
For Maryland policies issued, delivered, or renewed beginning January 1, 2026, private health plans cannot exclude qualifying specialty-drug coverage. The provider must be legally authorized, in-network for covered oncology services, and follow state specialty-drug rules. Covered types include infused or auto-injected drugs, oral targeted immune modulators, and oral drugs requiring complex dosing or accompanying infusion or radiation treatment. A specialty drug must treat a complex, chronic, or rare condition and cost at least $600 for up to 30 days. It must also be uncommon at retail pharmacies and need special handling, delivery, or extra patient education or support. Drugs prescribed for diabetes, HIV, or AIDS are excluded from this definition. Plans can still deny treatment that does not meet medical-necessity standards.
Fairer specialty-drug payments for pharmacies
Beginning January 1, 2026, pharmacy benefit managers working for insurers face payment-parity rules for covered specialty drugs. They cannot pay a pharmacy or pharmacist less than themselves or an affiliated business for the same product or service. The law includes a specialty-drug exception and carve-outs for mail-order pharmacies and chains with more than 15 stores. It also bars requiring patients to use a specific pharmacy, except for specialty-drug arrangements allowed by the law. These protections do not set patient prices or guarantee savings.
Payment rules for specialty-drug providers
Beginning January 1, 2026, health plans and covered in-network providers must agree on payment for specialty drugs covered by this law. Providers must bill these drugs at a nonhospital level of care or place of service. Payment cannot exceed the designated specialty pharmacy's rate unless the plan and provider agree otherwise. The Health Services Cost Review Commission keeps its rate-setting authority in settings it regulates. These payment rules do not guarantee lower patient bills.
Sponsors & Cosponsors
Sponsor
Steve Johnson
Democratic • House
Cosponsors
Tiffany T. Alston
Democratic • House
Heather Bagnall
Democratic • House
Harry Bhandari
Democratic • House
Brian Chisholm
Republican • House
Bonnie Cullison
Democratic • House
Pam Lanman Guzzone
Democratic • House
Terri L. Hill
Democratic • House
Thomas S. Hutchinson
Republican • House
Anne R. Kaiser
Democratic • House
Kenneth Kerr
Democratic • House
Nicholaus R. Kipke
Republican • House
Lesley J. Lopez
Democratic • House
Matthew Morgan
Republican • House
Ashanti Martinez
Democratic • House
Joseline A. Peña-Melnyk
Democratic • House
Teresa E. Reilly
Republican • House
Samuel I. Rosenberg
Democratic • House
Kim Ross
Democratic • House
Kathy Szeliga
Republican • House
Deni Taveras
Democratic • House
Jennifer White Holland
Democratic • House
Jamila J. Woods
Democratic • House
Teresa Woorman
Democratic • House
Roll Call Votes
Senate vote • 4/2/2025
Third Reading Passed
Yes: 46 • No: 0 • Other: 1
House vote • 3/13/2025
Third Reading Passed
Yes: 137 • No: 2 • Other: 1
Actions Timeline
Approved by the Governor - Chapter 729
5/20/2025Returned Passed
4/2/2025HouseThird Reading Passed (46-0)
4/2/2025SenateSecond Reading Passed
3/28/2025SenateFavorable Adopted
3/28/2025SenateFavorable Report by Finance
3/27/2025SenateReferred Finance
3/17/2025SenateThird Reading Passed (137-2)
3/13/2025HouseSecond Reading Passed with Amendments
3/12/2025HouseFavorable with Amendments {733628/1 Adopted
3/12/2025HouseFavorable with Amendments Report by Health and Government Operations
3/12/2025HouseHearing 2/27 at 2:00 p.m.
2/26/2025HouseHearing canceled
2/26/2025HouseHearing 2/27 at 1:00 p.m.
2/12/2025HouseFirst Reading Health and Government Operations
2/7/2025House
Bill Text
Enacted
5/20/2025
Third Reading
3/12/2025
First Reading
2/7/2025
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