Republican lawmakers revisit step therapy circumventions

by | Nov 17, 2023

  • Republican lawmakers Rep. Karen Gonzalez Pittman and Sen. Gayle Harrell are proposing legislation to exempt Medicaid beneficiaries with serious mental illnesses from step therapy, allowing them to access more direct treatments if medically necessary.
  • The bills largely mirror past unsuccessful measures put forth by the pair earlier this year to bypass step therapy regulations when deemed appropriate. 
  • Step therapy, a common approach in mental health treatment covered by insurance, requires patients to try less expensive treatments first, which can delay access to more effective medications.

In an effort to recirculate past legislative efforts, Republican lawmakers Rep. Karen Gonzalez Pittman and Sen. Gayle Harrell have filed measures ahead of the coming Legislative Session to exempt Medicaid beneficiaries with serious mental illnesses from step therapy practices.

If adopted, the legislation would allow patients with conditions including bipolar disorder, major depressive disorders, and schizophrenia to bypass step therapy procedures if their doctors provide necessary medical documentation. Harrell’s bill has already been referred to the Health Policy and Fiscal Policy Senate committees for review.

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.

“A drug product may be approved or, in the case of a drug product for the treatment of a serious mental illness, must be approved without meeting the step-therapy prior authorization criteria if the prescribing physician provides the agency with additional written medical or clinical documentation that the product is medically necessary,” reads Harrell’s bill.

Gonzalez Pittman and Harrell each filed legislation earlier this year to bypass step therapy, but the measures failed to pass a House vote despite being approved by the Senate. Amid committee deliberations, the pair of lawmakers held press events to drum up support.

“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 during an April press conference. “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.”

During the event, Gonzalez Pittman also presented findings from a 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 legislation’s initial iterations received backing from the Florida Psychiatric Society Legislative Task Force, which contended at the time 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 separate study, he stated that step therapy practices cost taxpayers over $274 million annually via missed workdays, medical expenses like pharmaceuticals, and inpatient costs.


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