Health Insurance - Step Therapy or Fail-First Protocols - Drugs to Treat Associated Conditions of Advanced Metastatic Cancer

HB 1087 prohibits Maryland health insurers, nonprofit health plans, and health maintenance organizations from requiring step therapy (where patients must try less expensive drugs first) for two specific cancer-related treatments. It applies when: (1) a drug treats stage 4 metastatic cancer itself (if FDA-approved and supported by medical evidence), or (2) a drug treats a symptom or side effect from cancer treatment (if determined necessary by a provider and backed by medical literature). The law affects patients with advanced metastatic cancer who rely on these specific prescription drugs and requires insurers to cover them without prior authorization hurdles. The bill amends Maryland insurance law and takes effect January 1, 2026.