---
type: "Bill"
title: "Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols"
description: "Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols"
jurisdiction: "us/states/md"
legislature: "Maryland General Assembly"
session: "2025"
identifier: "SB 646"
citation: "Maryland SB 646 (2025)"
classification: ["bill"]
subjects: []
status: "enacted"
primary_sponsors: ["Muse"]
version_count: 3
action_count: 13
vote_count: 2
first_action: "2025-01-29"
last_action: "2025-05-20"
source: "openstates"
source_identifier: "ocd-bill/70480a1a-ec91-47c9-9bc7-6a36af0727f4"
source_url: "http://mgaleg.maryland.gov/mgawebsite/Legislation/Details/sb0646?ys=2025RS&search=True"
source_hash: "510212e44de96325bedc7857706d9df1286c0622dcef0a859dde179dc47b5ae7"
vintage: "2026-07-01"
source_snapshot: "https://data.openstates.org/daily/2026-07-01/public.pgdump"
retrieved_at: "2026-07-06"
confidence: "reported"
tags: ["legislation", "bill", "us-md"]
---

# Maryland SB 646 (2025) — Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols

## Version chain

The bill's text revisions, in order — the diff chain from filing to enrollment.

1. **Chapter - Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols** (committee substitute) — [source](http://mgaleg.maryland.gov/2025RS/Chapters_noln/CH_689_sb0646t.pdf)
2. **First - Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols** (committee substitute) — [source](http://mgaleg.maryland.gov/2025RS/bills/sb/sb0646f.pdf)
3. **Third - Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols** (committee substitute) — [source](http://mgaleg.maryland.gov/2025RS/bills/sb/sb0646t.pdf)

## Votes

- On Third Reading — **137–0** (pass) · lower
- On Third Reading — **46–0** (pass) · upper

## Sponsors

- Muse — primary (person)

## Timeline

The legislative action history — every referral, reading, and vote.

- **2025-01-29** First Reading Finance `referral-committee`
- **2025-02-06** Hearing 2/26 at 1:00 p.m.
- **2025-03-31** Favorable with Amendments Report by Finance `committee-passage-favorable`
- **2025-03-31** Favorable with Amendments { `committee-passage-favorable`
- **2025-03-31** Second Reading Passed with Amendments
- **2025-04-01** Third Reading Passed `passage`
- **2025-04-02** Referred Rules and Executive Nominations `referral-committee`
- **2025-04-02** Rereferred to Health and Government Operations
- **2025-04-04** Favorable Report by Health and Government Operations `committee-passage-favorable`
- **2025-04-04** Favorable Adopted Second Reading Passed `committee-passage-favorable`
- **2025-04-07** Third Reading Passed `passage`
- **2025-04-07** Returned Passed
- **2025-05-20** Approved by the Governor - Chapter 689 `executive-signature`

## Source

OpenStates / OpenCivicData bulk snapshot [2026-07-01](https://data.openstates.org/daily/2026-07-01/public.pgdump); origin `ocd-bill/70480a1a-ec91-47c9-9bc7-6a36af0727f4`. Confidence: reported (aggregated from official Maryland legislature records).