According to the National Alliance on Mental Illness, in 2021, over 1.8 million adults in Pennsylvania had a mental health condition, and over 440,000 of these adults had a mental health condition that was considered a serious mental illness. Access to medication can be critical for people living with serious mental illnesses, including conditions like bipolar disorder, major depressive disorder, or schizophrenia. In many cases, multiple trials or different medications are needed to find a treatment that works for the patient, as not all treatments have the intended effect for every person.
 
Step therapy policies, also sometimes referred to as “fail first” protocol, require that a person take their insurer’s preferred medication and demonstrate that the medication does not work for them, before they may use a different medication. While step therapy policies and other prior authorization requirements may lower costs for insurers, they also contribute to delays in effective care, raise health care costs, can lead to adverse effects for the patient, and do not allow health care providers the ability to initially prescribe medication they feel would work for their patient.
 
For these reasons, I am introducing legislation to prohibit insurers, Medicaid, and the Children’s Health Insurance Program (CHIP) from imposing prior authorization requirements and step therapy policies for medications used to treat serious mental illnesses. In doing so, my legislation will remove barriers to treatment and ensure that the well-being of each person seeking treatment is prioritized.
 
Please consider joining me in co-sponsoring this legislation to guarantee adequate and timely access to necessary mental health medications for all Pennsylvanians.
 

Statutes/Laws affected:
Printer's No. 1775 (May 29, 2025): P.L.682, No.284