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 health insurers, nonprofit health plans, and HMOs cannot require patients to try other drugs before covering qualifying prescriptions. This applies to policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after that date, including coverage through pharmacy benefit managers. For stage four advanced metastatic cancer symptoms or treatment side effects, the drug must be FDA-approved and covered by the plan. A treating doctor must prescribe it, and its use must follow best practices and be supported by peer-reviewed medical research. The protection also covers FDA-approved drugs used to treat the cancer itself when their use follows FDA-approved or National Comprehensive Cancer Network guidance and has peer-reviewed research support. Plans cannot avoid these protections by giving their try-other-drugs-first rule a different name.