Health Insurance - Coverage for Specialty Drugs

SB 975 requires insurers, nonprofit health plans, and health maintenance organizations (HMOs) in Maryland to cover specialty drugs administered by in-network oncology providers meeting state regulations. It prohibits exclusions for specific specialty drugs (like infused, auto-injected, or complex oral medications) when dispensed by qualifying providers, defined as drugs costing $600+ for a 30-day supply, not stocked at retail pharmacies, and treating complex chronic conditions (excluding diabetes/HIV/AIDS drugs). The bill mandates reimbursement rates based on agreements between providers and insurers at non-hospital care levels. This directly affects patients needing these specialty drugs and the insurers/HMOs providing their coverage.