Bill > SB975

This bill aims to regulate health insurance coverage for specialty drugs by prohibiting certain insurers, health service plans, and health maintenance organizations from excluding coverage for specialty drugs when they are administered or dispensed by an in-network oncology provider who complies with state regulations. A "specialty drug" is defined as a prescription medication for complex, chronic, or rare medical conditions that costs $600 or more for a 30-day supply, is not typically stocked at retail pharmacies, and requires special handling or patient support, with exceptions for drugs treating diabetes, HIV, or AIDS. The bill requires that reimbursement rates for these drugs be agreed upon by the in-network provider and the insurance entity, and billed at a non-hospital level of care, with a maximum rate not exceeding that of a designated specialty pharmacy. Insurers are still allowed to deny coverage if the drug does not meet medical necessity criteria. The legislation will apply to all health insurance policies, contracts, and plans issued or renewed in the state on or after January 1, 2026, and is designed to provide more flexibility and access for patients needing specialized medical treatments.

Budget and Finance, Government Affairs, Health and Social Services

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/SB0975?ys=2025RS