HB 970 Maryland House of Delegates · 2025 Regular Session

Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols

HB 970 prohibits Maryland health insurers, nonprofit health plans, and health maintenance organizations from requiring patients to try less expensive diabetes medications before covering insulin. It directly affects people with type 1, type 2, or gestational diabetes who rely on insulin or similar insulin analogs for treatment. The bill bans "step therapy" or "fail-first" protocols - where insurers force patients to attempt alternative drugs first - regardless of how insurers label these policies. This change takes effect for all new or renewed health insurance policies on or after January 1, 2026.

Issues: ✓ Healthcare

Bill status signed all 5 stages cleared

Introduction

Jan 2025

Committee Review

Apr 2025

House of Delegates Passage

Apr 2025

Senate Passage

Apr 2025

Signed into Law

May 2025

Introduced Jan 31, 2025 Signed May 20, 2025

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What changed between versions

Third - Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols → Enrolled - Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols · 3 edits · May 20, 2025

MINOR

The bill was formally enrolled and approved by the Governor, transitioning from a House draft to an official state law. The substantive policy text remains largely unchanged, with the primary modifications being the addition of the 'Enrolled Bill' header, proofreader signatures, and the Great Seal presentation details required for final enactment.

Scope change

The scope of the law itself did not change; the bill continues to prohibit insurers from using step therapy or fail-first protocols for insulin and certain cancer medications. The only scope-related change is the formal transition of the document status from 'House Bill' to 'Enrolled Bill', indicating it has passed both chambers and received executive approval.

TECHNICAL

Added 'Enrolled Bill' header and proofreader signature lines to reflect the bill's final passage and preparation for the Governor.

Added the Great Seal presentation date line and signatures for the Speaker and Senate President to complete the official enrollment process.

Reformatted the sponsor list and header information to match the standard layout for enrolled legislation.

Floor votes · Senate Mar 15, 2025 · House of Delegates Mar 22, 2025

How they voted

45–0

Passed · 1 other

Total votes 46

Mar 15, 2025

D Democratic33

32 Yea 1

96% Yea

R Republican13

13 Yea

100% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Amendments

May 20, 2025

Signed into law

Approved by the Governor - Chapter 688

executive

Apr 5, 2025

Lower · Passed

Passed Enrolled

lower

Apr 5, 2025

Lower · Passed

Third Reading Passed

lower

Apr 5, 2025

Introduced

House Concurs Senate Amendments

lower

Apr 3, 2025

Introduced

House Refuses Concur Senate Amendments

lower

Apr 2, 2025

Upper · Passed

Third Reading Passed

upper

Apr 1, 2025

Upper · Passed

Favorable with Amendments {

upper

Mar 31, 2025

Upper · Passed

Favorable with Amendments Report by Finance

upper

Mar 22, 2025

House Of Delegates · Passed

House of Delegates Vote: pass (132-0-7)

house of delegates

Mar 15, 2025

Senate · Passed

Senate Vote: pass (45-0-1)

senate

Mar 12, 2025

Committee

Referred Finance

upper

Mar 11, 2025

Lower · Passed

Third Reading Passed

lower

Mar 11, 2025

Lower · Passed

Favorable with Amendments {

lower

Mar 10, 2025

Lower · Passed

Favorable with Amendments Report by Health and Government Operations

lower

Jan 31, 2025

Committee

First Reading Health and Government Operations

lower

38 primary · 0 co-sponsors

Sponsors

Role

Legislator

Party

State

District