Florida bill that aims to prohibit Medicaid coverage of step therapy passes Senate Committee on Health Policy
On Feb. 20th, Florida’s Senate Committee on Health Policy unanimously passed Senate Bill 112, which seeks to remove step therapy protocols for Medicaid recipients for the treatment of serious mental illness (SMI).
Step therapy is a common insurance practice that establishes which prescription drugs and medical treatments are covered by insurance companies and programs like Medicaid.
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“Step therapy is a process where patients are required to go through steps, which are sort of tiers of medication,” obstetrician and gynecologist (OB/GYN) Dr. Sujatha Prabhakaran told State of Reform. “They’re required, usually, to try less expensive medicines that maybe the insurer prefers before they can move onto a different medication that might be more expensive.”
Prabhakaran, who has experience working with individuals with postpartum depression, said step therapy has good intentions by aiming to assist with cost control. However, it can result in weeks-or-months-long delays in access to needed medication for patients. An economic study conducted by the Regional Consulting Group analyzed Florida’s step therapy protocols for patients with major depressive disorder and found that step therapy costs state taxpayers over $271.5 million annually.
According to the study, total workplace costs exceeded $238.8 million, while direct medical costs and costs related to suicides were over $32 million. For Medicaid managed care plans, step therapy costs were $52.3 million, including $600,000 in suicide costs.
Prabhakaran explained how the delays in receiving effective medication can be harmful to not only patients experiencing mental health distress, but also the economy.
“Just delaying treatment for mental illness … has really difficult effects on the person’s life, particularly for moms who have either recently delivered a child, or who are pregnant—it can really mean that they either can’t take care of their own health as well as they want to, or they can’t take care of their new little one,” Prabhakaran told State of Reform.
According to Prabhakaran, weeks of delays in treatment means patients are experiencing difficulty functioning for weeks, including feelings of sadness, less productivity at work and time out of work, and even hospitalization.
“We definitely know from talking with our physicians, our OB/GYNS, and also our psychiatry colleague that these protocols are definitely protocols that they run into on a regular basis with Medicaid patients,” Prabhakaran told State of Reform.
According to the study, 385,828 Floridians with major depressive disorder have had step therapy procedures applied to them. She brought up how her mother’s untreated postpartum depression led to her suicide.
“We know those effects are just completely preventable, which is why a bill like this one is so important,” Prabhakaran told State of Reform.
SB 112 would require the Agency for Health Care Administration to approve medications for Medicaid recipients to treat SMI, including bipolar disorders, depression in childhood or adolescence, major depressive disorders, obsessive-compulsive disorders, paranoid personality disorders, schizoaffective disorders, and schizophrenia, without step therapy prior authorization.
“It just takes away some of that delay that we know is both harmful to the patient themselves, and then also just costs the healthcare system more money too,” Prabhakaran told State of Reform.
As of Feb. 23rd, SB 112 is in the Appropriations Committee on Health and Human Services awaiting further consideration.