Drew Wilson
reThink Brain Health Florida is supporting legislation to allow certain Medicaid beneficiaries to bypass step therapy and prior authorization protocols.
Also known as “fail first” procedures, step therapy is a common insurance practice that requires patients to try less expensive medications before they can receive coverage for the medication recommended by their physician. This trial-and-error process can force patients to try multiple medications before they are able to get their prescribed treatment.
Legislation in the House and Senate (SB 112/HB 183) would allow Medicaid beneficiaries to skip those protocols if they are diagnosed with a serious mental illness.
The list of conditions enumerated in the proposal: bipolar disorders, including hypomanic, manic, depressive, and mixed-feature episodes; depression in childhood or adolescence; major depressive disorders, including single and recurrent depressive episodes; obsessive-compulsive disorders; paranoid personality disorder or other psychotic disorders; schizoaffective disorders, including bipolar or depressive symptoms; and schizophrenia.
reThink Brain Health Florida said the proposals would lead to better health outcomes for patients while also producing savings for the state.
An economic study conducted by Regional Economic Consulting Group (REC Group) analyzed Florida’s step therapy practices for patients with major depressive disorders, which are one of the most common serious mental illnesses.
“Our analysis found that the negative outcomes associated with step therapy practices have a significant cost to Florida,” said Jared Parker, co-founder of REC and an economic consultant with 10 years of experience in economic analysis of legislative policies in Florida. “When patients are not receiving effective treatment, they are more likely to miss work, be less productive at work, and experience inpatient and emergency room hospitalizations. Any short-term cost reduction associated with step therapy practices is far outweighed by the overarching costs.”
The study found that step therapy costs the state economy $271.5 million a year. Florida Medicaid beneficiaries account for $52.3 million of the overall cost, which the report breaks down as $45.9 million in workplace costs, $5.8 million in medical costs, and $600,000 in suicide costs.
“As we work to address the mental health crisis and make Florida the top state where families, communities, and businesses can thrive, it’s important that state lawmakers take this step forward by supporting HB 183 and SB 112,” said Julio Fuentes, President of the Florida State Hispanic Chamber of Commerce. “This isn’t just an issue that impacts patients. It impacts business owners, employers, workers, taxpayers — our entire state.”
The Senate bill, sponsored by Stuart Republican Sen. Gayle Harrell, has cleared two committee stops with unanimous votes and is awaiting a hearing in the Senate Fiscal Policy Committee, which is its final stop before the chamber floor. The House companion, sponsored by Tampa Republican Rep. Karen Gonzalez Pittman, has not yet been heard in committee.
