A new law that will help diabetes patients who rely on insulin for their care will take effect next year. Maryland Governor Wes Moore signed the bill into law on Tuesday. It will prohibit state-regulated insurance plans from imposing ‘step therapy’.
This approach requires patients to try one or more less expensive or insurer-preferred insulin options instead of using the prescribed insulin recommended by their doctor.
American Diabetes Association Supports New Law
Maryland is now the first state in the country to mandate optimal insulin therapy for state regulated health plans. The American Diabetes Association (ADA) applauded the new law.
Monica Billger is the director of state government affairs for the ADA. She tells MCM, “Not all insulins are created equal. What works for one person, might not work for another. For example, certain insulins might work too rapidly. That can cause severe hypoglycemia (low blood glucose). Others might not be absorbed into the body as effectively. This can cause severe hyperglycemia (high blood glucose.) Either situation creates sub-optimal blood glucose control and more blood glucose fluctuations. This can increase the risk of complications to the patient.”
Insulin Benefits
Diabetes impacts more than 1 in 10 Marylanders. Many of them depend on insulin to stay healthy. Patients with Type 1 diabetes rely on insulin to help regulate their bodies. Meantime, some people with Type 2 diabetes also may require insulin.
“It has long been acknowledged that insulin is a life-saving medication. Twenty-seven states including Maryland and the District of Columbia have lowered out-of-pocket costs for the populations they serve who take insulin. However, this new law recognizes the importance of affordable access to the right insulin for each individual. Critical patient-centered care should be standard, but it is not. This law, in Maryland, has broken a long-standing barrier for insulin users and will serve as an inspiration and guiding light for policy changes in other states. We hope they will embrace a new standard of care and the correct approach to insulin access nationwide,” Billger explained.
Law Only Applies To Some Insurers
The new law only covers state-regulated plans. Those include insurance plans sold under the Affordable Care Act’s (ACA) individual and small group marketplaces, and fully insured employer-sponsored plans. The law will not impact private insurers. Many of these insurers may use ‘step therapy’ as a way to control costs. They opposed the new law. The companies said providing optimal insulin could lead to higher premiums and increase overall healthcare costs.
Billger disagrees. She believes ‘step therapy’ does not hold down costs. Billger said, “The wrong medication or a delay in treatment imposed by ‘step therapy’ protocols can result in significant medical expenses associated with an adverse reaction.”
She also said ‘step therapy’ has the potential to make a patient’s condition worse or create complications in their care.
The law will take effect in January 2026.
