Two lawmakers from the Republican party, Representative Karen Gonzalez Pittman and Senator Gayle Harrell, have introduced legislation that aims to make it easier for Medicaid beneficiaries with serious mental illnesses to receive their medication. The House version of the bill, HB 491, was introduced by Rep. Pittman, while the Senate version, SB 268, was presented by Sen. Harrell. Both bills are currently being considered during the upcoming 2024 legislative session, which begins in January.
Step therapy is a practice that requires patients to try a less expensive drug before switching to a more expensive one based on their effectiveness. Under the proposed legislation, Medicaid beneficiaries with conditions such as bipolar disorder, major depressive disorder and schizophrenia would be able to skip step therapy if their doctors provide documentation of medical necessity.
During the previous legislative session in 2023, the Senate approved a bill that aimed to make this change but it failed to pass the House. However, most Medicaid beneficiaries receive care through managed care plans. As a result, both bills would direct the state’s Agency for Health Care Administration to take into account how this proposed change could impact rates paid for managed care plans. Ultimately, this change would ensure that those with serious mental illnesses have access to more affordable and effective medication.