Restrictions on Step Therapy or Fail-First Protocol

On May 3, 2023, Gov. Moore signed HB 785/SB 515 into law, addressing protocols imposed by health insurers that require an insured to use a certain prescription drug or sequence of prescription drugs before covering a prescription drug ordered by a provider (known as “step therapy” or “fail-first” protocols).

Specifically, the law requires health insurers in Maryland to establish a process for insureds to request an exception to a step therapy or fail-first protocol, with deference to the prescriber. The law also prohibits requiring more than a certain number of prior authorizations for a prescription for different dosages of the same prescription drug. As of January 1, 2024, the law applies to policies issued or delivered in the state. Employers sponsoring health plans in Maryland should be aware of this development and contact their carriers for further information.

HB 785 »