Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Pharmaceutical Access topic
No spam. Unsubscribe anytime.
Committee hears bill to bar step‑therapy ‘fail‑first’ protocols for insulin; sponsors cite patient safety
Summary
HB 970 would prohibit insurers from imposing step‑therapy or 'fail‑first' requirements for insulin and similar diabetes medications; proponents said step therapy delays can cause ER visits and irreversible harm, while PBM and insurer representatives say current practice rarely forces life‑threatening delays and asked to work on precise language.
Delegate Woods presented House Bill 9 70 to the House Health and Government Operations Committee, seeking to prohibit Maryland insurers and health plans from imposing step‑therapy or "fail‑first" protocols for insulin and certain similar diabetes medications.
Sponsor’s view and testimony: "Patients should not be obligated to just wait and see if a medication will fail before having access to potentially life‑saving medication," Delegate Woods said, arguing that prior‑authorization delays and step‑therapy requirements have in some studies resulted in emergency department visits and hospitalizations. Monica Bilger of the American Diabetes Association said the group supports the bill to ensure "providers, not insurers, will have the final say in selecting the appropriate insulin for their patients." She described cases from other states of severe adverse events after step therapy requirements.
Insurer, PBM and trade perspectives: Michael Johansen of the Pharmaceutical Care Management Association said PBMs implement utilization tools only at the direction of plan sponsors and that many plans already follow best practices that avoid step therapy for insulin. He flagged language in the bill that could extend protections too broadly to newly marketed agents or different administration methods, raising concerns about cost and unintended consequences. Johansen said carriers and PBMs are willing to negotiate clarifying amendments.
Committee discussion: Members asked witnesses whether Maryland had documented incidents of insulin denial for type‑1 patients; witnesses said they had not seen documented Maryland cases but reiterated concern that absent a statutory prohibition new carriers or changes in practice could introduce step therapy in the future. The committee also discussed possible targeted fixes to the bill’s definitions to avoid unintended coverage problems for other drugs.
Outcome: The bill hearing drew support from patient advocates and diabetes organizations and cautious opposition from PBM representatives who requested clarifying language. No committee vote was recorded at the hearing.
