During the 2024 legislative session, two Republican lawmakers, Rep. Karen Gonzalez Pittman and Sen. Gayle Harrell, have introduced bills that would 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.
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. This change would provide more accessible and effective medication to those with serious mental illness.
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, these bills would direct the state Agency for Health Care Administration to consider the effects of this proposed change in rates paid to managed-care plans.