A Senate committee Wednesday approved a proposal that supporters said would help Medicaid beneficiaries with mental illnesses get prescription drugs they need.
The Senate Health Policy Committee unanimously approved the proposal (SB 264), which Sen. Gayle Harrell, R-Stuart, has filed for the legislative session that will start March 4.
The bill would create an exception to what is known as “step therapy” for a series of psychiatric conditions, such as bipolar disorders, major depressive disorders and obsessive compulsive disorders.
Lawmakers in 2022 approved such an exception for drugs used to treat schizophrenia.
The Medicaid program uses a “preferred drug list,” with drugs on the list also tied to rebates offered by drug manufacturers.
If doctors determine it is necessary to prescribe drugs not on the preferred list, it triggers prior-authorization and step therapy requirements. Generally, that means trying less-expensive drugs before moving to drugs that cost more.
Harrell and other supporters of the bill said it is important for doctors to be able to prescribe appropriate medications to people with mental illnesses without having to first use other drugs that are not effective.
A Senate staff analysis, however, said the state Agency for Health Care Administration, which runs the Medicaid program, thinks the proposed change could affect the program’s budget.
“If numerous prescribing physicians elect to prescribe drugs that are not on the PDL (preferred drug list) under the bill, it may lead to an increase in net drug cost in therapeutic classes related to serious mental illness,” the staff analysis said. “The AHCA estimates a significant overall fiscal increase to the Florida Medicaid program of up to $50 million per year could be possible due to utilization changes and potential loss of supplemental rebates.”
