Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols

Maryland bans try-first rules for insulin

Beginning January 1, 2026, covered Maryland health plans cannot require patients to try other drugs before covering prescribed insulin. This includes insulin analogs used for type 1, type 2, or gestational diabetes. The rule covers insurers, nonprofit health service plans, and health maintenance organizations, including drug coverage handled through pharmacy benefit managers. It applies to policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after that date. The law does not itself guarantee insulin coverage or lower its price. It also retains try-first protections for FDA-approved drugs used to treat stage four advanced metastatic cancer. Those uses must match an FDA-approved indication or the National Comprehensive Cancer Network Drugs & Biologics Compendium and have peer-reviewed medical support.