2023 LEGISLATIVE SESSION January 11 - April 10, 2023

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Maryland Rare
  • Home
  • 2023 State Legislation
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    • Utilization Management
    • Step Therapy
    • Genetic Testing
  • RAre News Flash
  • MD General Info
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    • Maryland General Assembly
  • Community Resources

Step Therapy

SB0515/HB0785

Senate Bill - SB0515 - Status - Click Here


Link to Bill:  Health Insurance – Step Therapy or Fail–First Protocol – Revisions


Synopsis: Prohibiting certain insurers, nonprofit health service plans, and health maintenance organizations from imposing a step therapy or fail-first protocol on an insured or an enrollee for certain prescription drugs used to treat a certain mental disorder or condition; and requiring certain insurers, nonprofit health service plans, or health maintenance organizations to establish a certain process for requesting an exception to a step therapy or fail-first protocol.


Sponsored by:  Senators Lam


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House Bill - HB0785 - Status - Click Here


Link to Bill - Health Insurance – Step Therapy or Fail–First Protocol – Revisions


Sponsored by: Delegates S. Johnson and White




Want to take Action

Step Therapy or Fail First Protocol:


Feb. 22 @ 1pm, Senate Finance

Contact

More information

National Psoriasis Foundation

For more information:  Click Here

Additional Information

Maryland’s law currently only allows a patient to override a step therapy protocol if the patient has already  been on a drug for 180 days and the prescriber attests that the patient is doing well on the drug. This  legislation recognizes there may be other clinical reasons why a patient cannot or should not take a certain  drug. Therefore, the legislation will require a carrier to establish a process for requesting an exception to a  step therapy protocol if, based on the professional judgement of a prescriber, the prescription drug required  to be used by a step therapy protocol  

• is contraindicated or will likely cause an adverse reaction, physician harm, or mental harm to the  patient; or 

• is expected to be ineffective based on the known clinical characteristics of the patient and the known  characteristics of the prescription drug regimen; or 

• the patient is stable on a prescription drug selected by their health care provider; or • the patient has already tried a prescription drug in the same pharmacologic class or has the same  mechanism of action as the step therapy drug and was discontinued by the prescriber due to lack of  efficacy or effectiveness, diminished effect, or an adverse event.  

This legislation also exempts from step therapy protocols a prescription drug that is used to treat the insured or enrollee’s mental disorder or condition under certain conditions.  


Contact: Danna Kauffman, Schwartz, Metz, Wise & Kauffman, PA, dkauffman@smwpa.com, 410-244-7000



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