Bill would bar preferential treatment for opioids over non‑opioid pain drugs; industry and PBM groups warn of interference with utilization management

House Bill 1013 would require the Maryland Medical Assistance Program and private health insurers to cover non‑opioid drugs for pain to the same extent as opioid medicines, removing a structural preference for opioids when clinically appropriate non‑opioid options exist.

Sponsor Delegate Ken Kerr told the committee that recent drug-development advances — including a newly approved class of peripheral sodium channel blockers — create viable non‑opioid alternatives for acute and chronic pain. “This bill allows access to a variety of non opioid options already available,” Kerr said, adding that the bill would not prohibit utilization-management tools such as prior authorization and step therapy where clinically appropriate but would prevent opioids from being given preferential treatment simply because they are inexpensive on the front end.

Advocates including Chris Fox, executive director of Voices for Non Opioid Choices, said the bill is intended to reduce exposure to opioids that can lead to persistent use and addiction. “Make no mistake, this over reliance on opioids comes at a cost, both in human loss and an increased overall health care spending,” Fox said.

Industry witnesses urged caution. Michael Johansen of the Pharmaceutical Care Management Association, representing pharmacy benefit managers, said utilization‑management decisions — including prior authorization, step therapy and fail‑first protocols — should be made by health plans, their medical directors and PBMs rather than by statute. He said some non‑opioid agents may require clinical safeguards similar to those placed on certain NSAIDs or other agents and that the bill as written could constrain clinically appropriate management.

Vertex Pharmaceuticals’ representative Adam Bradshaw attended as an informational resource about a newly approved drug in the class the sponsor described; he said more products are in development but declined to provide specific commercialization timelines.

The Department of Health’s fiscal analysis noted potential costs for state programs if new products are covered without prior authorization constraints; supporters argued long‑term savings from reduced opioid addiction and overdose costs could offset short‑term spending.

No committee vote was recorded at the hearing. Members questioned sponsors and panelists about which non‑opioid comparators the bill is meant to address and whether the statutory language could be clarified to limit unintended consequences.

Why it matters: The bill attempts to rebalance incentives that favor opioid prescribing and to ensure that innovative or novel non‑opioid therapies have timely access if clinically appropriate. Opponents say the bill risks hampering clinical and cost‑management tools used by insurers and PBMs.

What comes next: The committee will consider technical edits and stakeholder concerns before further action; sponsors signaled willingness to refine language about utilization management.