SB0490 • 2026

Maryland Medical Assistance Program - Step Therapy, Fail-First Protocols, and Prior Authorization - Prescription Drugs to Treat Serious Mental Illness

Healthcare

Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor: Senator Lam
Last action: 2026-02-03
Official status: In the Senate - Hearing 2/17 at 1:00 p.m.
Effective date: 2026-07-01

Plain English Breakdown

Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill text.

Maryland Medical Assistance Program - Step Therapy, Fail-First Protocols, and Prior Authorization - Prescription Drugs to Treat Serious Mental Illness

Prohibiting the Maryland Medical Assistance Program from applying a prior authorization requirement in certain circumstances to and from applying a step therapy or fail-first protocol for a prescription drug used to treat an adult enrollee's diagnosis of bipolar disorder, schizophrenia, major depression, post-traumatic stress disorder, or a medication-induced movement disorder associated with the treatment of serious mental illness.

What This Bill Does

Prohibiting the Maryland Medical Assistance Program from applying a prior authorization requirement in certain circumstances to and from applying a step therapy or fail-first protocol for a prescription drug used to treat an adult enrollee's diagnosis of bipolar disorder, schizophrenia, major depression, post-traumatic stress disorder, or a medication-induced movement disorder associated with the treatment of serious mental illness.

Limits and Unknowns

This entry is temporarily using official source text because the generated explanation could not be confirmed against the official bill text during the last sync.

Bill History

2026-02-03 Senate
Hearing 2/17 at 1:00 p.m.
2026-02-02 Senate
First Reading Finance
Maryland General Assembly
Text - First - Maryland Medical Assistance Program - Step Therapy, Fail-First Protocols, and Prior Authorization - Prescription Drugs to Treat Serious Mental Illness

Official Summary Text

Prohibiting the Maryland Medical Assistance Program from applying a prior authorization requirement in certain circumstances to and from applying a step therapy or fail-first protocol for a prescription drug used to treat an adult enrollee's diagnosis of bipolar disorder, schizophrenia, major depression, post-traumatic stress disorder, or a medication-induced movement disorder associated with the treatment of serious mental illness.

Current Bill Text

Read the full stored bill text

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
*sb0490*

SENATE BILL 490
J1 6lr3119
CF 6lr3117
By: Senator Lam
Introduced and read first time: February 2, 2026
Assigned to: Finance

A BILL ENTITLED

AN ACT concerning 1

Maryland Medical Assistance Program – Step Therapy, Fail–First Protocols, and 2
Prior Authorization – Prescription Drugs to Treat Serious Mental Illness 3

FOR the purpose of prohibiting the Maryland Medical Assistance Program from applying 4
a prior authorization requirement in certain circumstances to and from applying a 5
step therapy or fail –first protocol for a prescription drug used to treat an adult 6
enrollee’s diagnosis of bipolar disorder, schizophrenia, major depression, 7
post–traumatic stres s disorder, or a medication –induced movement disorder 8
associated with the treatment of serious mental illness; and generally relating to the 9
Maryland Medical Assistance Program and coverage of drugs to treat serious mental 10
illness. 11

BY adding to 12
Article – Health – General 13
Section 15–160 14
Annotated Code of Maryland 15
(2023 Replacement Volume and 2025 Supplement) 16

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 17
That the Laws of Maryland read as follows: 18

Article – Health – General 19

15–160. 20

(A) IN THIS SECTION, “STEP THERAPY OR FAIL–FIRST PROTOCOL” HAS THE 21
MEANING STATED IN § 15–142 OF THE INSURANCE ARTICLE. 22

2 SENATE BILL 490

(B) EXCEPT AS REQUIRED UN DER 42 U.S.C. § 1396A, BEGINNING JULY 1, 1
2026, THE PROGRAM MAY NOT APPLY A PRIOR AUTHORIZATION REQUIREMENT FOR 2
A PRESCRIPTION DRUG USED TO TREAT AN ADULT ENROLLEE’S DIAGNOSIS OF: 3

(1) BIPOLAR DISORDER; 4

(2) SCHIZOPHRENIA; 5

(3) MAJOR DEPRESSION; 6

(4) POST–TRAUMATIC STRESS DISORDER; OR 7

(5) A MEDICATION–INDUCED MOVEMENT DIS ORDER ASSOCIATED 8
WITH THE TREATMENT OF A SERIOUS MENTAL ILLNESS. 9

(C) BEGINNING JULY 1, 2026, THE PROGRAM MAY NOT APPLY A STEP 10
THERAPY OR FAIL–FIRST PROTOCOL FOR A PRESCRIPTION DRUG USED TO TREAT AN 11
ENROLLEE’S DIAGNOSIS OF: 12

(1) BIPOLAR DISORDER; 13

(2) SCHIZOPHRENIA; 14

(3) MAJOR DEPRESSION; 15

(4) POST–TRAUMATIC STRESS DISORDER; OR 16

(5) A MEDICATION–INDUCED MOVEMENT DIS ORDER ASSOCIATED 17
WITH THE TREATMENT OF A SERIOUS MENTAL ILLNESS. 18

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect July 19
1, 2026. It sh all remain effective for a period of 3 years and, at the end of June 30, 2029, 20
this Act, with no further action required by the General Assembly, shall be abrogated and 21
of no further force and effect. 22