# Maryland SB 0646: Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols

Maryland SB 0646, Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols, is a 2025 Regular Session Senate bill sponsored by C. Anthony Muse (Democratic); status signed, last action 2025-05-20 (Approved by the Governor - Chapter 689); PRIA reads it as touching household money (as of 2026-10-17).

- Canonical: https://policyrisk.com/state-bill/MD-SB0646-2025RS
- As of: 2026-10-17
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: Maryland SB 0646
- State: Maryland
- Session: 2025 Regular Session
- Title: Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols
- Status: signed
- Chamber: Senate
- Introduced: 2025-01-29
- Last action: 2025-05-20, Approved by the Governor - Chapter 689
- Sponsor: C. Anthony Muse (Democratic)
- Cosponsors: 0
- Subjects: Health - Insurance, Health Maintenance Organizations, Drugs -see also- Cannabis; ControlDangSubst; Pharm; etc., Health Insurance -see also- ACA; HMOs; MCOs, Health Maintenance Organizations -see also- Manage Care Orgs, Medical Conditions -see also- AIDS; COVID-19; rabies, Medical Treatments, Nonprofit Organizations
- Touches household money: yes
- Roll calls: 2 (183 yes, 0 no in all)
- Economic provisions PRIA read: 1

## Summary

No summary available.

## Bill overview: provisions PRIA read

- Maryland bans try-first rules for insulin: benefit, low. 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 or…

## Sponsors and cosponsors

- Sponsor: C. Anthony Muse (Democratic), Senate

## Roll call votes

| Date | Chamber | Motion | Result | Yes | No | Other |
| --- | --- | --- | --- | --- | --- | --- |
| 2025-04-07 | House | Third Reading Passed | pass | 137 | 0 | 4 |
| 2025-04-01 | Senate | Third Reading Passed | pass | 46 | 0 |   |

## Actions (13)

- 2025-05-20: Approved by the Governor - Chapter 689
- 2025-04-07: Returned Passed (Senate)
- 2025-04-07: Third Reading Passed (137-0) (House)
- 2025-04-04: Favorable Adopted Second Reading Passed (House)
- 2025-04-04: Favorable Report by Health and Government Operations (House)
- 2025-04-02: Rereferred to Health and Government Operations (House)
- 2025-04-02: Referred Rules and Executive Nominations (House)
- 2025-04-01: Third Reading Passed (46-0) (Senate)
- 2025-03-31: Second Reading Passed with Amendments (Senate)
- 2025-03-31: Favorable with Amendments {493829/1 Adopted (Senate)
- 2025-03-31: Favorable with Amendments Report by Finance (Senate)
- 2025-02-06: Hearing 2/26 at 1:00 p.m. (Senate)
- 2025-01-29: First Reading Finance (Senate)

## Bill text

- First Reading, 2025-05-20: [PDF](https://mgaleg.maryland.gov/2025RS/Chapters_noln/CH_689_sb0646t.pdf)
- First Reading, 2025-03-31: [PDF](https://mgaleg.maryland.gov/2025RS/bills/sb/sb0646t.pdf)
- First Reading, 2025-01-29: [PDF](https://mgaleg.maryland.gov/2025RS/bills/sb/sb0646f.pdf)

## Related bills

- HB 0384: Maryland Disability Service Animal Program - Established (vetoed)
- SB 0227: Workers' Compensation - Payment From Uninsured Employers' Fund - Revisions (vetoed)
- HB 0482: Occupational Licensing and Certification - Criminal History - Predetermination Review Process (vetoed)
- SB 0157: Maryland Disability Service Animal Program - Established (vetoed)
- HB 1294: Commercial Law - Credit Regulation - Earned Wage Access and Credit Modernization (became law)
- HB 0228: Maryland Veterans Trust – Assistance to Members of the Maryland National Guard (signed)

## Sources
- [First Reading (PDF)](https://mgaleg.maryland.gov/2025RS/Chapters_noln/CH_689_sb0646t.pdf)
- [First Reading (PDF)](https://mgaleg.maryland.gov/2025RS/bills/sb/sb0646t.pdf)
- [First Reading (PDF)](https://mgaleg.maryland.gov/2025RS/bills/sb/sb0646f.pdf)

## Related
- [HB 0384: Maryland Disability Service Animal Program - Established](https://policyrisk.com/state-bill/MD-HB0384-2025RS)
- [SB 0227: Workers' Compensation - Payment From Uninsured Employers' Fund - Revisions](https://policyrisk.com/state-bill/MD-SB0227-2025RS)
- [HB 0482: Occupational Licensing and Certification - Criminal History - Predetermination…](https://policyrisk.com/state-bill/MD-HB0482-2025RS)
- [SB 0157: Maryland Disability Service Animal Program - Established](https://policyrisk.com/state-bill/MD-SB0157-2025RS)
- [HB 1294: Commercial Law - Credit Regulation - Earned Wage Access and Credit Modernization](https://policyrisk.com/state-bill/MD-HB1294-2025RS)
- [HB 0228: Maryland Veterans Trust – Assistance to Members of the Maryland National Guard](https://policyrisk.com/state-bill/MD-HB0228-2025RS)
- [Maryland bills](https://policyrisk.com/states/maryland/bills)
- [Maryland state hub](https://policyrisk.com/states/maryland)
- [All state legislation](https://policyrisk.com/state-bills)

Source: PRIA, https://policyrisk.com/state-bill/MD-SB0646-2025RS (as of 2026-10-17).