Bill > SB961

This bill requires the Maryland Medical Assistance Program, health insurers, nonprofit health services plans, and health maintenance organizations to provide coverage for pharmacogenomic testing (a type of laboratory genetic testing that evaluates how an individual's genetic profile might affect medication efficacy, safety, or toxicity) under specific circumstances. Starting July 1, 2026, these entities must cover single-gene and multigene pharmacogenomic testing when a treating provider orders the test for a patient diagnosed with depression or anxiety, and the provider is considering a medication change, dose adjustment, or augmentation involving a medication with a known gene-drug interaction. The bill also establishes strict guidelines for prior authorization, requiring a clear and meaningful pathway for coverage, minimal documentation requirements, sufficient time frames for submitting requests, and prohibiting administrative barriers. Entities that do not comply may face monetary penalties up to $10,000 per instance of noncompliance, with an additional $1,000 daily penalty for continued non-compliance. The bill also mandates periodic audits and establishes a process for patients, prescribers, and laboratories to report instances of non-compliance. The legislation will take effect on October 1, 2025.

Budget and Finance

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/SB0961?ys=2025RS