Relating to step therapy protocols required by health benefit plans for coverage of prescription drugs for serious mental illnesses.
Impact
The legislation modifies existing health insurance regulations by amending Chapter 1369 of the Insurance Code, thereby protecting patients from potentially arduous protocols that may delay or prevent them from receiving adequate mental health care. This change is expected to facilitate quicker access to appropriate medications and improve treatment outcomes, which could decrease overall healthcare costs related to managing complications from mishandled mental health conditions. The bill takes effect on January 1, 2024, thereby impacting future health benefit plans and those renewed after this date.
Summary
House Bill 1337 seeks to reform step therapy protocols utilized by health benefit plans specifically for the treatment of serious mental illnesses. By establishing limitations on the use of prior authorization methods, the bill aims to ensure that enrollees aged 18 and older cannot be required to fail multiple medications before being covered for an FDA-approved drug. The intention behind this legislation is to improve access to necessary treatment for individuals affected by serious mental illnesses, which has been a growing concern in the state of Texas and beyond.
Sentiment
General sentiment surrounding HB 1337 appears positive, particularly among mental health advocates and healthcare providers. Supporters commend the bill for addressing a critical issue in mental health care access and applaud its potential to enhance patient welfare. However, concerns were raised by some segments of the insurance industry about the implications on cost and management of medications, fearing that it might lead to increased insurance expenses in the long term.
Contention
A notable point of contention revolves around the implications for insurance companies and the way they manage prescriptions for serious mental illnesses. Critics argue that limiting step therapy could result in higher immediate costs for insurance providers, while proponents assert that it will ultimately lead to better health outcomes and cost savings. The balance between managing healthcare costs and ensuring prompt access to essential medications illustrates a critical tension in ongoing healthcare discussions, emphasizing the need for thoughtful deliberation in health policy.
Texas Constitutional Statutes Affected
Insurance Code
Chapter 1369. Benefits Related To Prescription Drugs And Devices And Related Services
Maryland Medical Assistance Program and Health Insurance - Step Therapy, Fail-First Protocols, and Prior Authorization - Prescription Drugs to Treat Serious Mental Illness
Maryland Medical Assistance Program and Health Insurance - Step Therapy, Fail-First Protocols, and Prior Authorization - Prescription Drugs to Treat Serious Mental Illness