Prior Authorization in Maryland
Maryland enacted HB 920 (2023) establishing comprehensive PA reform. The law requires electronic PA, gold card exemptions for high-approval providers, and PA decisions within 2 business days for standard requests. Maryland also has step therapy override protections and robust external review.
Key Facts About PA in Maryland
- ✓ Standard PA decisions required within 2 business days
- ✓ Gold card exemptions for providers with 90%+ approval rates
- ✓ Electronic PA is mandated for health insurers
- ✓ Maryland Insurance Administration provides external review for denied claims
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Maryland
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Maryland carriers:
CareFirst BCBSUnitedHealthcareAetnaCigna