Public Health - Recommendations for Immunizations, Screenings, and Preventive Services - Pharmacist Administration and Required Health Insurance Coverage (The Vax Act)

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*sb0385*

SENATE BILL 385
J3, J5, J2 6lr0343
CF HB 637
By: The President (By Request – Administration) and Senators Augustine, Beidle,
Harris, Hettleman, Kagan, King, Lam, Lewis Young, Love, and Zucker
Introduced and read first time: January 27, 2026
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 4, 2026

CHAPTER ______

AN ACT concerning 1

Public Health – Recommendations for Immunizations, Screenings, and 2
Preventive Services – Pharmacist Administration and Required Health 3
Insurance Coverage 4
(The Vax Act) 5

FOR the purpose of requiring the Secretary of Health to issue recommendations for certain 6
immunizations, screenings, and preventive services based on certain evidence–based 7
scientific and clinical guidance; requiring the Secretary, before adopting a 8
recommendation for a certain preventive service, to hold a notice and comment 9
period, obtain a cer tain analysis from the Maryland Health Care Commission, and 10
cite the basis for the recommendation; altering the authority of pharmacists to 11
administer certain vaccinations; altering the health insurance coverage 12
requirements for certain immunizations, screenings, and preventive services; 13
repealing obsolete language regarding the pertussis vaccine; and generally relating 14
to immunizations, screenings, and preventive services. 15

BY repealing 16
Article – Health – General 17
Section 18–328 through 18–332 and the part “Part V. Pertussis” 18
Annotated Code of Maryland 19
(2023 Replacement Volume and 2025 Supplement) 20

BY adding to 21
Article – Health – General 22
2 SENATE BILL 385

Section 18–112 1
Annotated Code of Maryland 2
(2023 Replacement Volume and 2025 Supplement) 3

BY repealing and reenacting, with amendments, 4
Article – Health Occupations 5
Section 12–508 6
Annotated Code of Maryland 7
(2021 Replacement Volume and 2025 Supplement) 8

BY repealing and reenacting, with amendments, 9
Article – Insurance 10
Section 15–1A–10 and 15–817 11
Annotated Code of Maryland 12
(2017 Replacement Volume and 2025 Supplement) 13

SECTION 1. BE IT ENACTED BY THE GENE RAL ASSEMBLY OF MARYLAND, 14
That Section(s) 18–328 through 18–332 and the part “Part V. Pertussis” of Article – Health 15
– General of the Annotated Code of Maryland be repealed. 16

SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 17
as follows: 18

Article – Health – General 19

18–112. 20

(A) THE SECRETARY SHALL ISSUE RECOMMENDATIONS FOR 21
IMMUNIZATIONS, SCREENINGS, AND PREVENTIVE SERVI CES FOR INFANTS , 22
CHILDREN, AND ADULTS THAT FOLL OW THE GENERALLY ACC EPTED CONSENSUS 23
WITHIN THE SCIENTIFI C COMMUNITY AND SOUN D CLINICAL GUIDANCE AS 24
SPECIFIED IN SUBSECTION (B) OF THIS SECTION AND SUBJECT TO SUBSECTION (C) 25
OF THIS SECTION. 26

(B) THE RECOMMENDATIONS SHALL: 27

(1) BE MADE IN ACCORDANCE WITH THE APPLICABLE 28
RECOMMENDATIONS OF T HE FOLLOWING AUTHORI TATIVE MEDICAL 29
ORGANIZATIONS: 30

(I) THE AMERICAN ACADEMY OF PEDIATRICS; 31

(II) THE AMERICAN COLLEGE OF OBSTETRICIANS AND 32
GYNECOLOGISTS; OR 33

SENATE BILL 385 3

(III) THE AMERICAN ACADEMY OF FAMILY PHYSICIANS; AND 1

(2) TAKE INTO CONSIDERATION THE APPLICABLE GUIDANCE OF: 2

(I) THE MARYLAND STATEWIDE ADVISORY COMMISSION ON 3
IMMUNIZATIONS; 4

(II) THE U.S. DEPARTMENT OF HEALTH AND HUMAN 5
SERVICES, INCLUDING THE HEALTH RESOURCES AND SERVICES ADMINISTRATION; 6

(III) THE U.S. CENTERS FOR DISEASE CONTROL AND 7
PREVENTION, INCLUDING THE ADVISORY COMMITTEE ON IMMUNIZATION 8
PRACTICES; 9

(IV) THE U.S. FOOD AND DRUG ADMINISTRATION, INCLUDING 10
THE VACCINES AND RELATED BIOLOGICAL PRODUCTS ADVISORY COMMITTEE; 11
AND 12

(V) THE U.S. PREVENTIVE SERVICES TASK FORCE. 13

(C) BEFORE ADOPTING A REC OMMENDATION FOR A PREVENTIVE SERVICE 14
THAT IS NOT AN IMMUNIZATION AND HAS NOT RECEIVED A RECOMMENDATION FROM 15
THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OR AN A OR B RATING 16
FROM THE U.S. PREVENTIVE SERVICES TASK FORCE, THE SECRETARY SHALL: 17

(1) HOLD A NOTICE AND COMMENT PERIOD OF AT LEAST 30 DAYS; 18

(2) OBTAIN AN ANALYSIS FR OM THE MARYLAND HEALTH CARE 19
COMMISSION ON THE SERVICE THAT MEETS THE REQUIREMENTS OF § 15–1501 OF 20
THE INSURANCE ARTICLE; AND 21

(3) CITE THE APPLICABLE R ECOMMENDATIONS OF THE 22
AUTHORITATIVE MEDICAL ORGANIZATIONS ON WHICH A RECOMMENDATION WOULD 23
BE BASED. 24

(C) (D) THE SECRETARY SHALL: 25

(1) PUBLISH RECOMMENDATIONS ISSUED UNDER THIS SECTION ON 26
THE DEPARTMENT’S WEBSITE; AND 27

(2) DISTRIBUTE THE RECOMM ENDATIONS ISSUED UNDER THIS 28
SECTION TO LICENSED HEALTH PROFESSIONALS IN THE STATE AND TO THE 29
MARYLAND INSURANCE ADMINISTRATION. 30

4 SENATE BILL 385

Article – Health Occupations 1

12–508. 2

(a) (1) Subject to paragraph (4) of this subsection, a pharmacist may order and 3
administer a vaccination to an individual who is at least 3 years old if: 4

(i) The vaccine is: 5

1. An influenza vaccine; 6

2. A COVID–19 vaccine; or 7

3. Used in response to a public health emergency; 8

(ii) The pharmacist has completed a practical training program of at 9
least 20 hours that is approved by the Accreditation Council for Pharmacy Education and 10
includes: 11

1. Hands–on injection techniques; 12

2. Clinical evaluation of indications and contraindications of 13
vaccines; and 14

3. The recognition and treatment of emergency reactions to 15
vaccines; 16

(iii) The pharmacist has a current certificate in basic 17
cardiopulmonary resuscitation; 18

(iv) The pharmacist has completed a minimum of 2 hours of 19
continuing pharmaceutical education related to immun izations that is approved by the 20
Accreditation Council for Pharmacy Education as part of the license renewal requirements 21
under § 12–309 of this title; 22

(v) The pharmacist complies with the record–keeping and reporting 23
requirements in paragraph (5) of t his subsection and any corresponding regulations 24
adopted by the Board; and 25

(vi) If the vaccination is administered to an individual under the age 26
of 18 years, the pharmacist informs the child vaccination patient and adult caregiver who 27
is accompanying the child of the importance of well –child visits with a pediatric primary 28
care provider and refers the patient to a pediatric primary care provider when appropriate. 29

(2) Subject to paragraph (4) of this subsection, a pharmacist who has met 30
the requirement of paragraph (1)(ii) through (vi) of this subsection may administer to an 31
individual who is at least 7 years old a vaccination that is: 32
SENATE BILL 385 5

(i) Recommended by the Centers for Disease Control and 1
Prevention’s Advisory Committee on Immunization Practices; [or] 2

(ii) Approved or authorized by the U.S. Food and Drug 3
Administration; OR 4

(III) RECOMMENDED BY THE SECRETARY OF HEALTH IN 5
ACCORDANCE WITH § 18–112 OF THE HEALTH – GENERAL ARTICLE. 6

(3) Subject to paragraph (4) of this subsection, a pharmacist who has met 7
the requirement of paragraph (1)(ii), (iii), and (iv) of this subsection may administer to an 8
adult a vaccination that is recommended in the Centers for Disease Control and 9
Prevention’s Health Information for International Travel. 10

(4) [(i)] A pharmacist shall administer a vaccination under paragraph 11
(1), (2), or (3) of this subsection under a written protocol that: 12

[1.] (I) Is vaccine specific; and 13

[2.] (II) Meets criteria established by the Department, in 14
consultation with the Board, the Board of Physicians, and the Board of Nursing, in 15
regulation. 16

[(ii) The recommendations of the Centers for Disease Control and 17
Prevention’s Advisory Committee on Immunization Practices cited in this section refer to 18
federal statutes, rules, and guidance in effect: 19

1. On December 31, 2024; or 20

2. At a later date to account for any new vaccines 21
recommended by the Centers for Disease Control and Prevention’s Advisory Committee on 22
Immunization Practices after December 31, 2024.] 23

(5) A pharmacist shall: 24

(i) Report all vaccinations administered by the pharmacist to the 25
ImmuNet Program established under § 18–109 of the Health – General Article; 26

(ii) If the vaccination has been administered in accordance with a 27
prescription, document at least one effort to inform the individual’s authorized prescriber 28
that the vaccination has been administered; and 29

(iii) Except for an influenza vaccination administered under 30
paragraph (1) of this subsection, if the authorized prescriber is not the individual’s primary 31
care provider or if the vaccination has not been administered in accordance with a 32
6 SENATE BILL 385

prescription, document at least one effort to inform the individual’s primary care provider 1
or other usual source of care that the vaccination has been administered. 2

(b) The Board shall: 3

(1) Set reasonable fees for the administration of vaccinations under this 4
section; and 5

(2) Adopt regulations that require a pharmacist to submit a registration 6
form to the Board that includes verification that the pharmacist: 7

(i) Has successfully completed a certification course approved by the 8
Board [that included instruction in the guidelines and recommendations of the Centers for 9
Disease Control and Prevention regarding vaccinations in effect on December 31, 2024 ]; 10
and 11

(ii) Is certified in basic cardiopulmonary resuscitation and obtained 12
the certification through in–person classroom instruction. 13

Article – Insurance 14

15–1A–10. 15

(a) Subject to subsection (e) of this section and except as provided in subsections 16
(b), (c), and (d) of this section, a carrier shall provide coverage for and may not impose any 17
cost–sharing requirements, including copayments, coinsurance, or deductibles for: 18

(1) evidence–based items or services that have in e ffect a rating of A or B 19
in the recommendations of the United States Preventive Services Task Force with respect 20
to the individual involved; 21

(2) immunizations for routine use in children, adolescents, and adults that 22
have in effect a recommendation from the Advisory Committee on Immunization Practices 23
of the Centers for Disease Control and Prevention with respect to the individual involved, 24
if the recommendation: 25

(i) has been adopted by the Director of the Centers for Disease 26
Control and Prevention; or 27

(ii) is listed on the Immunization Schedules of the Centers for 28
Disease Control and Prevention for routine use; 29

(3) with respect to infants, children, and adolescents, evidence –informed 30
preventive care and screenings provided for in comprehensive guidelines supported by the 31
Health Resources and Services Administration; and 32

(4) with respect to women: 33
SENATE BILL 385 7

(i) to the extent not provided in item (ii) of this item, preventive care 1
and screenings as provided for in comprehensive guidelines supporte d by the Health 2
Resources and Services Administration for purposes of § 2713(a)(4) of the federal Public 3
Health Service Act; and 4

(ii) subject to § 15 –826(c) of this title, contraceptive coverage as 5
provided for in comprehensive guidelines supported by the Health Resources and Services 6
Administration for purposes of § 2713(a)(4) of the federal Public Health Service Act. 7

(b) To the extent that cost –sharing is otherwise allowed under federal or State 8
law, a health benefit plan that uses a network of pro viders may impose cost –sharing 9
requirements on the coverage described in subsection (a) of this section for items or services 10
delivered by an out–of–network provider. 11

(c) (1) In this subsection, “high deductible health plan” has the meaning stated 12
in 26 U.S.C. § 223(c)(2). 13

(2) If an insured or enrollee is covered under a high deductible health plan, 14
a carrier may apply the deductible requirement of the high deductible health plan to the 15
coverage required under subsection (a) of this section, unless the Commissioner determines 16
that the coverage is included in the safe harbor provisions for preventive care under 26 17
U.S.C. § 223(c)(2)(c). 18

(d) This section may not be construed to prohibit a carrier from providing 19
coverage for services in addition to thos e recommended by the United States Preventive 20
Services Task Force or to deny coverage for services that are not recommended by the Task 21
Force. 22

(e) Subject to § 15–826(c) of this title[: 23

(1)], the Commissioner shall enforce this section consistent with the 24
recommendations and guidelines in effect on December 31, 2024, set by the United States 25
Preventive Services Task Force, the Advisory Committee on Immunization Practices of the 26
Centers for Disease Control and Prevention, or the Health Resources and Ser vices 27
Administration, and related federal rules or guidance[; and 28

(2) the Commissioner may adopt regulations: 29

(i) necessary to carry out this section, consistent with federal 30
statutes, rules, and guidance in effect: 31

1. on December 31, 2024; or 32

2. at a later date that enhance the scope of preventive 33
services to the benefit of consumers in the State; or 34

8 SENATE BILL 385

(ii) to require carriers to provide coverage without imposing 1
cost–sharing requirements, including copayments, coinsurance, or deductibles, for any 2
future preventive services recommendations and guidelines issued after December 31, 3
2024, by the United States Preventive Services Task Force, the Advisory Committee on 4
Immunization Practices of the Centers for Disease Control and Prevention, or the Health 5
Resources and Services Administration, and related federal rules or guidance], AS 6
UPDATED BY RECOMMENDATIONS ISSUED BY THE SECRETARY OF HEALTH IN 7
ACCORDANCE WITH § 18–112 OF THE HEALTH – GENERAL ARTICLE. 8

(F) A CARRIER SHALL PROVIDE THE COVERAGE DESCRIBED IN SUBSECTION 9
(A) OF THIS SECTION FOR PLAN YEARS THAT BEGIN ON OR AFTER THE DATE THAT IS 10
3 MONTHS 1 YEAR AFTER THE DATE THE R ECOMMENDATIONS DESCR IBED IN 11
SUBSECTION (E) OF THIS SECTION ARE ISSUED. 12

15–817. 13

(a) In this section, “child wellness services” means preventive activities designed 14
to protect children from morbidity and mortality and promote child development. 15

(b) This section applies to each individual hospital or major medical insurance 16
policy, group or blanket health insurance policy, and nonprofit health service plan that: 17

(1) is delivered or issued for delivery in the State; 18

(2) is written on an expense–incurred basis; and 19

(3) provides coverage for a family member of the insured. 20

(c) (1) A policy or plan subject to this section shall include under the family 21
member coverage a minimum package of child wellness services that are consistent with: 22

(i) public health policy; 23

(ii) professional standards; and 24

(iii) scientific evidence of effectiveness. 25

(2) The minimum package of child wellness services shall cover at least: 26

(i) all visits for and costs of childhood and adolescent immunizations 27
recommended by the Advisory Committee on Immunization Practices of the Centers for 28
Disease Control and Prevention a s of December 31, 2024 , AS UPDATED BY 29
RECOMMENDATIONS ISSUED BY THE SECRETARY OF HEALTH IN ACCORDANCE WITH 30
§ 18–112 OF THE HEALTH – GENERAL ARTICLE; 31

SENATE BILL 385 9

(ii) visits for the collection of adequate samples, the first of which is 1
to be collected before 2 week s of age, for hereditary and metabolic newborn screening and 2
follow–up between birth and 4 weeks of age; 3

(iii) universal hearing screening of newborns provided by a hospital 4
before discharge; 5

(iv) all visits for and costs of age –appropriate screeni ng tests for 6
tuberculosis, anemia, lead toxicity, hearing, and vision as determined by the American 7
Academy of Pediatrics; 8

(v) all visits for obesity evaluation and management; 9

(vi) all visits for and costs of developmental screening as 10
recommended by the American Academy of Pediatrics; 11

(vii) a physical examination, developmental assessment, and 12
parental anticipatory guidance services at each of the visits required under items (i), (ii), 13
(iv), (v), and (vi) of this paragraph; and 14

(viii) any laboratory tests considered necessary by the physician as 15
indicated by the services provided under items (i), (ii), (iv), (v), (vi), or (vii) of this paragraph. 16

(d) Except as provided in subsection (e) of this section, an insurer or nonprofit 17
health service plan that issues a policy or plan subject to this section, on notification of the 18
pregnancy of the insured and before the delivery date, shall: 19

(1) encourage and help the insured to choose and contact a primary care 20
provider for the expected newborn before delivery; and 21

(2) provide the insured with information on postpartum home visits for the 22
mother and the expected newborn, including the names of health care providers that are 23
available for postpartum home visits. 24

(e) An insurer or nonprofit health service plan that does not require or encourage 25
the insured to use a particular health care provider or group of health care providers that 26
has contracted with the insurer or nonprofit health service plan to provide services to the 27
insurer’s or nonprofit health service plan’s insureds need not comply with subsection (d) of 28
this section. 29

(f) (1) A policy or plan subject to this section may not impose a deductible on 30
the coverage required under this section. 31

(2) Each health insurance policy and certificate shall contain a notice of the 32
prohibition established by paragraph (1) of this subsection in a form approved by the 33
Commissioner. 34

10 SENATE BILL 385

(g) The Commissioner may adopt regulations necessary to carry out subsection 1
(c)(2)(i) of this section consistent with federal statutes, rules, and guidance in effect[: 2

(1)] on December 31, 2024[; or 3

(2) at a later date to account for any new vaccines recommended by the 4
Centers for Disease Control and Prevention’s Advisory Committee on Immunization 5
Practices after December 31, 2024 ], AS UPDATED BY RECOMM ENDATIONS ISSUED BY 6
THE SECRETARY OF HEALTH IN ACCORDANCE WITH § 18–112 OF THE 7
HEALTH – GENERAL ARTICLE. 8

SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall apply to all 9
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 10
after January 1, 2027. 11

SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect July 12
1, 2026. 13

Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.