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

This bill prohibits health insurers, nonprofit health service plans, and health maintenance organizations in Maryland from requiring step therapy (a process where patients must try and fail on a cheaper drug before getting coverage for a more expensive one) for certain prescription drugs used to treat stage four advanced metastatic cancer or its associated symptoms/side effects. Specifically, it bans step therapy for drugs that are FDA-approved for treating the cancer itself, or for drugs treating a symptom or side effect from cancer treatment that a doctor determines will harm the patient if left untreated. The prohibition applies only when the drug use aligns with FDA approval, cancer treatment guidelines, and peer-reviewed medical literature. This law will take effect for all health insurance policies in Maryland issued, delivered, or renewed on or after January 1, 2026.