The topic of mental health is at the forefront of Texans these days and ensuring access to needed care is a priority of the Texas House of Representatives this legislative session. The Legislature has an opportunity to remove barriers so that doctors and patients can make the determination on what is the best course of treatment.
Last session, I passed legislation that removes barriers for Medicaid patients with severe mental illness by allowing them to maintain access to the medication that is working for them. We know that the individual and societal impacts of disruptions in medication can result in a major life disruption, including job loss, homelessness and encounters with the criminal justice system.
Based on my work last session, I along with the support of many stakeholders have crafted House Bill 1337 that will remove costly barriers to healthcare to all Texas patients seeking treatment for serious mental illness and reduce the time families must wait to get the right treatment their doctors believe are best for them.
Proper access to healthcare must start with reforming an insurance practice called “step therapy,” or ‘fail first.’ When a doctor wishes to prescribe their patient a new, innovative medication they believe will be most effective against their patient’s symptoms, step therapy requires that the patient first show that several cheaper alternatives to that medication did not adequately treat their illness. In other words, cheaper alternatives must first “fail” before insurance will cover a potentially more expensive treatment originally prescribed by a healthcare provider.
While I am no fan of overly burdensome insurance mandates, which at times can drive up the cost of healthcare, there is a need to address certain barriers that have demonstrated adverse outcomes for Texas patients. While it may come with cost savings to insurers, unchecked step therapy is a burden to our economy because it causes untreated or improperly treated patients to be admitted for costly emergency care or enter our criminal justice system.
The intention of these step therapy requirements is to lower costs for payers; if a cheaper version of a medication can treat a patient’s condition just as well as a newer, more expensive version, what sense does it make for the insurance company to cover the latter? Unfortunately, it is not that simple.
The American Journal of Psychiatry states over 60% of mental health patients enrolled in step therapy are unable to achieve success within the first 8 weeks. In addition to the potential of developing new, unwanted side effects from trying these alternative medications during this lengthy period, having to show failure of multiple medications often deters patients from seeking treatment all-together.
The legislation I have filed, House Bill 1337 would ensure better access to prescribed medication by limiting the step therapy to ‘one step’, meaning that a patient would only need to determine if one cheaper alternative of a prescribed medication is not suitable for their needs. The legislation also limits the use of step therapy to a maximum of once a year for each medication prescribed.
While these provisions may seem like small, bureaucratic changes to an already over-complicated regulation in our health care system, they would make the world of difference to those most impacted by mental illnesses and their families. The changes would drastically reduce delays in accessing provider-prescribed medications, and in doing so, would allow doctors to better treat their patients in a responsible and timely way.
Editor’s Note: The above guest column was penned by state Rep. Lacey Hull of Houston. The column appears in The Rio Grande Guardian International News Service with the permission of the author. Hull can be reached by email via: [email protected]
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