Two bills have been introduced by two Republican lawmakers, Rep. Karen Gonzalez Pittman and Sen. Gayle Harrell, to allow Medicaid beneficiaries with serious mental illness to bypass step therapy when receiving medications. The House version of the proposal, HB 491, was filed by Rep. Pittman, while the Senate version, SB 268, was filed by Sen. Harrell. These bills are set for consideration during the 2024 legislative session starting in January.
Step therapy is a practice that requires patients to try a less expensive medication before moving on to a more costly one, based on their effectiveness. The proposed bills would enable Medicaid beneficiaries with conditions such as bipolar disorder, major depressive disorders, and schizophrenia to skip step therapy if their physicians provide documentation of medical necessity.
During the 2023 legislative session, the Senate approved a bill that would have made this change, but it did not pass the House. Since most Medicaid beneficiaries receive care through managed-care plans, the bills would direct the state Agency for Health Care Administration to consider the effects of the proposed change in rates paid to managed-care plans.
This change would provide more accessible and effective medication to those with serious mental illness who currently must undergo step therapy before receiving their preferred treatment option. The bills aim to improve healthcare outcomes for these individuals and ensure they receive timely and appropriate care for their conditions.
In conclusion, these two bills introduced by Rep. Karen Gonzalez Pittman and Sen. Gayle Harrell seek to improve healthcare accessibility and outcomes for Medicaid beneficiaries with serious mental illness who currently undergo step therapy before receiving their preferred treatment option. The House version of the proposal (HB 491) was filed by Rep. Pittman while the Senate version (SB 268) was filed by Sen. Harrell both set for consideration during the 2024 legislative session starting in January.