Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

Maryland program

Fairer cost-sharing rules for covered chemotherapy pills

Maryland-regulated plans that cover both kinds of chemotherapy cannot put worse cost rules on pills than on IV treatment.

What it is

Maryland-regulated plans that cover both kinds of chemotherapy cannot put worse cost rules on pills than on IV treatment.

Pills can mean months of pharmacy charges during treatment. On a plan Maryland regulates the pill cannot be priced worse than the drip. A separate monthly cap on specialty drugs may also apply, depending on the drug; the pharmacist can check both.

Eligibility rules
  • The parity rule covers eligible Maryland-issued or delivered insured contracts covering both oral and intravenous chemotherapy. Self-funded employer plans fall outside the state insurance mandate.
  • A specialty drug must meet the statutory definition, including a cost of at least $600 for up to a 30-day supply and the remaining listed conditions.
  • These insurance statutes do not establish the same benefits for every self-funded plan. Public plans are not automatically governed by ERISA, but that does not make every Maryland mandate apply. A state employee, teacher or municipal benefits office must identify the current plan document or separate law providing oral-chemotherapy parity or a specialty-drug cap.
What you get
  • No less favorable dollar limits, copays, deductibles or coinsurance for covered oral chemotherapy.
  • A separate cap for drugs meeting Maryland's specialty-drug definition.
What the help covers
  • A plan cannot comply by reclassifying chemotherapy or raising other chemotherapy costs.
  • The specialty-drug cap limits the copay or coinsurance, not the deductible, on drugs costing $600 or more for a month’s supply that need special handling. It started at $150 a month and rises each July; ask the plan for this year’s figure.
If you decide to apply
  1. Ask the plan how your child's oral chemotherapy is priced compared with covered IV chemotherapy.
  2. Have the drug name, pharmacy bill and plan benefit explanation ready.
  3. If the charge seems wrong, ask the Maryland Insurance Administration to review which rule applies.

The plan; the Maryland Insurance Administration enforces · 1-800-492-6116 · Official page ↗

After you apply
  • The insurer's written comparison can explain the charge. The Maryland Insurance Administration handles complaints about regulated plans.
Good to know

The specialty-drug cap increases each July. Its $150 statutory base is not the current cap.

Other details
  • A separate Maryland rule, for plans issued or renewed from 2026, makes a drug maker’s copay card count toward your deductible and yearly limit when the drug has no preferred equivalent. If a credit is missing from a statement, ask the plan why. (this is a copay-accumulator card folded into the chemo-pill card; give it its own card)
Official sources
Ask your social worker

“Are our child's chemo pills being charged fairly compared with IV treatment? Could you help check the specialty-drug rule too and explain whether requesting a review would help?”

Why I’m asking: Repeated pharmacy charges matter, and I want to know whether the plan has priced them correctly.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Compare the first pharmacy bill with what the drip would have cost, and ask in writing.

Your social worker

The oncology pharmacist can say what the drip would have cost under the plan.

The care team

Records and letters when the application asks for them.

Who decides
The plan applies it; the Maryland Insurance Administration enforces it.
Ask your social worker
“My child's chemotherapy is now a pill. What would the same treatment by drip have cost under our plan, and what is this year's specialty drug copay cap?”

How to apply

First step: When the first pharmacy bill arrives, ask the plan in writing how it compares with the drip.

  1. When the first pharmacy bill arrives, compare it with what the drip would have cost under the plan.
  2. Ask the plan for this year's specialty drug cost-sharing cap in writing.
  3. If the pill costs more, complain to the Maryland Insurance Administration.

Official application / program page ↗

Where it starts: Ask the plan in writing how the pill is being priced against the drip, and what this year's specialty drug cap is.

What to gather

  • The pharmacy receipt or explanation of benefits
  • The plan's summary of benefits

How long: Immediate: it is how the plan has to price the drug.

What a yes looks like

The pill's cost sharing matches or beats the drip's, and the monthly charge sits under the cap.

What a no looks like, and the next move

Complain to the Maryland Insurance Administration on 1-800-492-6116, with the two figures side by side.

Watch out

  • Self-funded employer plans sit outside Maryland insurance law.
  • The specialty drug cap rises every July and this year's figure was not published. Ask the plan rather than quoting the base.
  • A drug has to meet the specialty definition; chemotherapy does not qualify by name alone.

Dates that change this

2026-07-01: The specialty drug cap rises every July 1 by a price index. The 2026 indexed figure was not published, so $150 is the statutory base, not this year's cap. Ask the plan.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Chemotherapy taken by mouth priced no worse than chemotherapy by drip. A specialty drug copay cap with a statutory base of $150 for up to a 30-day supply, raised every July.

  • $150/month — Statutory base cap on a specialty drug copay or coinsurance for up to a 30-day supply, before the annual July increase
  • $600/month — Cost for up to a 30-day supply at or above which a drug can meet the specialty definition

Legal protection: No less favourable dollar limits, copayments, deductibles or coinsurance on orally administered cancer chemotherapy · A plan cannot reclassify chemotherapy or raise other chemotherapy costs to comply · The specialty drug cap rises every July by the change in the medical care price index

What it costs the family: Whatever the plan charges for chemotherapy by drip, and no more, for chemotherapy by mouth.

The eligibility facts, as published

Plan type
Maryland-issued or delivered insurer, nonprofit health service plan and health maintenance organization contracts that cover both routes of chemotherapy. Self-funded employer plans sit outside Maryland insurance law.
Drug test
A drug must meet the specialty definition, including a cost of $600 or more for up to a 30-day supply and the other listed conditions. Chemotherapy does not qualify by name alone.

The trap: The specialty drug cap has a statutory base of $150 for up to a 30-day supply, but it rises every July with a price index and the current figure was not published. Do not quote $150 as this year's number: ask the plan what this year's cap is.

Where I read this

← Back to your options