MarylandSB 09752025 Regular SessionSenateWALLET

Health Insurance - Coverage for Specialty Drugs

Sponsored By: Clarence K. Lam (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 OrganizationsReimbursement Rates

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 0 costs, 1 mixed.

More specialty drug coverage for patients

The law applies to Maryland health plans issued, delivered, or renewed on or after January 1, 2026. Plans cannot exclude qualifying specialty drugs dispensed or administered by eligible providers in-network for covered cancer care. Providers must meet state licensing and regulatory requirements. Covered types include auto-injected drugs, oral targeted immune modulators, and oral medicines with complex dosing or used with infusion or radiation. Specialty drugs must cost at least $600 for up to 30 days and treat a complex, chronic, or rare condition. They must also be uncommon at retail pharmacies and need special handling, delivery, storage, distribution, or extra patient education or management. Drugs prescribed for diabetes, HIV, or AIDS do not qualify under this definition. Plans can still deny coverage when medical-need requirements are not met.

Equal specialty drug payments for pharmacies

Beginning January 1, 2026, pharmacy benefits managers working for health insurers must extend payment-parity protections to these covered specialty drugs. They cannot pay a pharmacy or pharmacist less than they pay themselves or an affiliate for the same product or service. This protection excludes chains with more than 15 stores and pharmacists employed by those chains. It does not set what patients pay.

Negotiated drug payments with provider caps

Beginning January 1, 2026, health plans and eligible in-network providers can agree on payment rates for these covered specialty drugs. Without an agreement to another rate, payment cannot exceed the rate for a designated specialty pharmacy. The drugs must be billed at a nonhospital level of care or place of service. Maryland’s Health Services Cost Review Commission keeps its rate-setting authority for specialty drugs administered in settings it regulates.

Sponsors & Cosponsors

Sponsor

Clarence K. Lam
Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 181 • No: 2

House vote • 4/7/2025

Third Reading Passed

Yes: 134 • No: 2 • Other: 4

Senate vote • 3/31/2025

Third Reading Passed

Yes: 47 • No: 0

Actions Timeline

Approved by the Governor - Chapter 728
5/20/2025
Returned Passed
4/7/2025Senate
Third Reading Passed (134-2)
4/7/2025House
Favorable Adopted Second Reading Passed
4/3/2025House
Favorable Report by Health and Government Operations
4/3/2025House
Rereferred to Health and Government Operations
4/2/2025House
Referred Rules and Executive Nominations
4/1/2025House
Third Reading Passed (47-0)
3/31/2025Senate
Second Reading Passed with Amendments
3/28/2025Senate
Favorable with Amendments {263927/1 Adopted
3/28/2025Senate
Favorable with Amendments Report by Finance
3/27/2025Senate
Hearing 2/26 at 1:00 p.m.
2/6/2025Senate
First Reading Finance
2/3/2025Senate

Bill Text

Enacted
5/20/2025
PDF
Third Reading
3/28/2025
PDF
First Reading
2/3/2025
PDF

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