Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Mental Health Medication Access topic
No spam. Unsubscribe anytime.
Lawmakers hear testimony to prohibit step‑therapy and prior authorization for some serious mental illnesses
Summary
House Bill 382 would bar step‑therapy and prior‑authorization protocols for drugs treating specified serious mental illnesses, a sponsor and mental‑health advocates told the committee, arguing the policies delay effective treatment and can worsen outcomes.
Delegate Steve Johnson opened the hearing on House Bill 382, which would ban step‑therapy and prior‑authorization requirements for medications used to treat certain serious mental illnesses: schizophrenia spectrum disorders, bipolar disorder, major depression, post‑traumatic stress disorder and medication‑induced movement disorder associated with treatment of serious mental illness.
Sponsor testimony and a large coalition of advocates—NAMI Maryland, Mental Health Association of Maryland, community behavioral health organizations and consumer advocates—argued that step‑therapy and prior‑authorization delays can cause clinical deterioration, hospitalizations and other high‑cost downstream events. NAMI Maryland’s deputy director, Michael Gray, and Mental Health Association representatives told the committee that clinical judgment should determine medication choice and that the fiscal note understates potential savings from reduced hospitalizations and emergency care.
Advocates cited studies and analytics suggesting higher inpatient and total medical costs when formulary restrictions delay access to appropriate antipsychotics in schizophrenia and bipolar disorder (examples in testimony: 23 percent higher inpatient costs and 16 percent higher total medical costs in cited analyses). Providers and some consumers gave personal examples of long prior‑authorization processes that delayed access and required repeated appeals.
Insurer witnesses, including representatives for the League of Life and Health Insurers and CareFirst Blue Cross Blue Shield, opposed a blanket prohibition. They supported more targeted approaches, pointed to recently enacted authorization and step‑therapy reforms the legislature passed in prior years, and cited fiscal notes that estimated increased costs in Medicaid and state employee plans. Insurers also urged time to evaluate recent changes that took effect and to avoid an across‑the‑board mandate without further study.
Sponsor and advocates responded by pointing to data from other states and to a built‑in termination provision in the bill that would suspend Medicaid coverage if state Medicaid costs increased beyond a specified threshold, and said a pilot or phased approach could be considered.
Ending: The committee heard extensive testimonies from clinicians, patient advocates and insurers. Advocates urged passage to prevent life‑threatening delays for people with serious mental illness; insurers warned of cost impacts and asked for more study and calibration. No formal committee vote was recorded in the hearing transcript.
