PRIA Logo™
MarylandSB 07732025 Regular SessionSenateWALLET

Health Benefit Plans - Calculation of Cost-Sharing Contribution - Requirements

Sponsored By: Stephen S. Hershey (Republican)

Signed by Governor

Health - InsuranceConsumer ProtectionDrugs -see also- Cannabis; ControlDangSubst; Pharm; etc.Health -see also- COVID19; EnvHlth; MedCon; etc.Health Insurance -see also- ACA; HMOs; MCOsHealth Maintenance Organizations -see also- Manage Care OrgsInsurance AdministrationMedical AssistanceNonprofit OrganizationsNoticesPharmacy Benefits ManagersRevenue and Taxes -see also- (specific tax)Rules and RegulationsSunset

Personalized for You

How does this bill affect your finances?

Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.

Free to download

Bill Overview

Analyzed Economic Effects

3 provisions identified: 3 benefits, 0 costs, 0 mixed.

Drug assistance counts toward patients’ costs

For Maryland plans issued, delivered, or renewed starting January 1, 2026, eligible drug assistance counts toward patients’ cost sharing. This includes copays, coinsurance, deductibles, and out-of-pocket limits for covered drugs. The drug must lack a plan-preferred AB-rated generic equivalent or interchangeable biologic, unless coverage originally came through prior authorization, step therapy, an exception, or an appeal. The counting rule excludes the deductible requirement for federally defined high-deductible health plans. The rule ends July 1, 2029.

Patients get clear drug assistance notices

Beginning January 1, 2026, providers of assistance used in cost-sharing calculations must notify patients within 7 days after acceptance. Notices must give the maximum dollar amount and expiration date; charities are exempt from this provider notice rule. Violating that rule violates the Maryland Consumer Protection Act. Third parties paying cost sharing or other covered prescription costs must also notify patients within 7 days after acceptance, stating the total help available and its duration. These notice rules end July 1, 2029.

Drug assistance cannot dictate patients’ coverage

For Maryland plans issued, delivered, or renewed starting January 1, 2026, regulated entities cannot base coverage or benefit design on drug assistance availability or amounts. Plans can still use rebates when designing drug benefits. Beginning January 1, 2026, third parties cannot require a specific health plan or plan type to provide covered drug assistance, unless federal law allows it. This protection covers help with cost sharing and other out-of-pocket drug costs. These restrictions end July 1, 2029.

Sponsors & Cosponsors

Sponsor

  • Stephen S. Hershey

    Republican • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 366 • No: 1

House vote • 4/7/2025

Third Reading Passed

Yes: 137 • No: 0 • Other: 4

Senate vote • 4/7/2025

Third Reading Passed

Yes: 47 • No: 0

House vote • 4/5/2025

Third Reading Passed

Yes: 135 • No: 1 • Other: 1

Senate vote • 3/12/2025

Third Reading Passed

Yes: 47 • No: 0

Actions Timeline

  1. Approved by the Governor - Chapter 692

    5/20/2025

  2. Passed Enrolled

    4/7/2025Senate

  3. Third Reading Passed (137-0)

    4/7/2025House

  4. Conference Committee Report {653120/1 Adopted

    4/7/2025House

  5. Third Reading Passed (47-0)

    4/7/2025Senate

  6. Conference Committee Report {653120/1 Adopted

    4/7/2025Senate

  7. House Conference Committee Appointed (Delegates Cullison, S. Johnson and Kipke)

    4/7/2025Senate

  8. House Refuses Recede

    4/7/2025Senate

  9. House Conference Committee Appointed (Delegates Cullison, S. Johnson and Kipke)

    4/7/2025House

  10. House Refuses Recede

    4/7/2025House

  11. Senate Conference Committee Appointed (Senators Hershey, Lam and Gile)

    4/7/2025House

  12. Senate Requests House Recede

    4/7/2025House

  13. Senate Refuses Concur House Amendments

    4/7/2025House

  14. Senate Conference Committee Appointed (Senators Hershey, Lam and Gile)

    4/7/2025Senate

  15. Senate Requests House Recede

    4/7/2025Senate

  16. Senate Refuses Concur House Amendments

    4/7/2025Senate

  17. Third Reading Passed (135-1)

    4/5/2025House

  18. Second Reading Passed with Amendments

    4/4/2025House

  19. Favorable with Amendments Adopted

    4/4/2025House

  20. Substitute Committee Amendment {683126/1 Adopted

    4/4/2025House

  21. Favorable with Amendments {263725/1 Withdrawn

    4/4/2025House

  22. Motion Special Order until Next Session (Delegate Cullison) Adopted

    4/3/2025House

  23. Favorable with Amendments {263725/1

    4/3/2025House

  24. Favorable with Amendments Report by Health and Government Operations

    4/3/2025House

  25. Hearing 3/27 at 1:00 p.m.

    3/15/2025House

Bill Text

  • Enacted

    5/20/2025

    PDF

  • Enrolled

    4/7/2025

    PDF

  • Third Reading

    3/11/2025

    PDF

  • First Reading

    1/31/2025

    PDF

Related Bills

Back to State Legislation