On May 13, 2019, Maryland Gov. Larry Hogan signed SB 504 into law, which will require health plans sold in the state to establish a process that allows patients to receive a prescription medication or device after it has been removed from the health plan’s formulary. This law will protect patients from losing access to their medications if their insurers change the coverage status of those medications or devices in the middle of the plan year.
Specifically, insurers subject to this requirement must establish a procedure that allows health plan enrollees either to receive a prescription medication or device that has been removed from the plan’s formulary or to continue receiving that medication or device with the same cost-sharing requirements if the medication or device was moved to a higher cost-sharing tier. For patients to be eligible to receive continued coverage in this manner, the original prescriber must verify that there is no equivalent medication or device on the entity’s formulary in a lower cost-sharing tier, or if there is an equivalent medication in a lower cost-sharing tier, it has been ineffective at treating the patient’s condition or it is likely to cause harm to them. Additionally, if a health plan makes any changes to its formulary, the plan will be required to provide 30-days’ advance notice to all enrollees who will be impacted by the change, as well as their health care provider.
This new law will take effect later this year on Oct. 1, 2019.