Lawmakers move closer to allowing Medicaid beneficiaries to bypass step therapy

by | Apr 3, 2023



  • The House Health Regulation Subcommittee has approved a bill, HB 183, that exempts Medicaid beneficiaries with severe mental illness from the practice of step therapy.
  • Step therapy is a method of mental health treatment that requires a patient to try a series of treatments, typically starting with the least expensive and least invasive options, before moving on to more intensive treatments if necessary.
  • The bill would allow patients with conditions such as bipolar disorder, major depressive disorders, and schizophrenia to avoid the step therapy process if their physicians submit documentation about the medical necessity.
  • The Senate version of the bill, SB 112, has already been approved by two committees. 

On Monday, the House Health Regulation Subcommittee unanimously passed a bill that exempts Medicaid beneficiaries with severe mental illness from the practice of step therapy when it comes to being prescribed medication.

The bill, HB 183, filed by Rep. Karen Gonzalez Pittman seeks to limit step therapy practices in treating mental and behavioral health. Step therapy is a method of mental health treatment that requires a patient to try a series of treatments, typically starting with the least expensive and least invasive options, before moving on to more intensive treatments if necessary. This approach is commonly used in insurance-covered mental health treatments.

Gonzalez Pittman’s legislation would allow Medicaid beneficiaries with conditions like bipolar disorder, major depressive disorders, and schizophrenia to be able to avoid the oftentimes lengthy step therapy process if their physicians submit documentation about the medical necessity.

“The insurances require step therapy, and that’s the process of failing first. What an insurance company wants to do is start with the lower-priced medication, and the patient tries that,” said Gonzalez Pittman. “These medications for serious mental illness take up to six weeks to work. The patient takes the first medication that we know wouldn’t work for six weeks, then they have to get another appointment, go to their doctor and try another medication, try that one for six weeks and see if it works.”

The Senate version of the bill, SB 112, filed by Sen. Gayle Harrell has already been approved unanimously by the Health Policy Committee and Appropriations Committee on Health and Human Services.

“This process can take up to a year while the patient and the physician know that there’s a medication out there that will treat their mental health,” continued Gonzalez Pittman.

Gonzalez Pittman recently presented findings from a recent study showing that one in four adults in Florida experienced mental illness in 2022 and that thirteen percent of young people in the state had at least one major depressive episode in the last year.

“Barriers to mental health care like step therapy prolong our state’s mental health crisis,” said Gonzalez Pittman. “This issue not only takes a toll on mental health patients and their families but on the state’s communities and economy.”

The proposed legislation received backing from the Florida Psychiatric Society Legislative Task Force, which argued that step therapy protocols often result in minimal cost savings and reiterated that it can cause patients to go without necessary treatment due to prolonged wait times.

Julio Fuentes, President and CEO of the Florida State Hispanic Chamber of Commerce, also threw his support behind the bills and highlighted the financial burden imposed by step therapy. Citing a recent study, he revealed that step therapy practices cost taxpayers over $274 million annually via missed workdays, medical expenses such as pharmaceuticals, and inpatient costs.

2 Comments

  1. Ron Kirkland

    Folks need appropriate medicine for serious disorders not expected to step thru hoops to get the right medicine! When in serious pain or mental distress addiction issues should be on a doctors advisement not a governmental regulation either!

  2. dmmorrison

    Fine, but isn’t accepting Medicaid expansion a more important thing to be focused on?

 

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