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

SB 646 prohibits health insurers, nonprofit health plans, and health maintenance organizations in Maryland from requiring patients to try cheaper diabetes medications first before covering insulin or similar drugs for Type 1, Type 2, or gestational diabetes. It specifically bans "step therapy" or "fail-first" protocols for insulin, insulin analogs, or other prescription drugs that perform insulin's function (regardless of delivery method). The law applies to all health plans issued, delivered, or renewed in Maryland after January 1, 2026, ensuring patients can access prescribed insulin without prior authorization hurdles. This directly affects diabetes patients and insurers covering prescription drugs under Maryland law.