Step Therapy Impairs Mental Health Treatment

Many common insurance and state Medicaid policies may hurt patient health and impose a major workload on psychiatrists, according to a report by the National Council for Behavioral Health and the National Alliance on Mental Illness (NAMI). More than 50% of psychiatrists in community mental health centers say that formulary restrictions, prior authorization and step therapy protocols are the most frequent roadblocks to an optimal treatment regimen. Step therapy protocols are sometimes referred to as “fail first policies” since they only allow psychiatrists to pursue different drug options after other treatments fail.

Three-quarters of psychiatrists spend more than 10% of their time on utilization management-related administrative tasks, with one in ten spending 40% or more of their time on such tasks. Three-quarters of psychiatrists say that patients have trouble complying with medication plans, and 62% say patients had more emergency department visits, hospitalizations, and increased health care costs. Nearly 90% of psychiatrists say that multiple medication options allow them to find the best fit for patients.

Linda Rosenberg, president and CEO of the National Council said, “Mental health treatments are not one size fits all. Choosing the right plan should be the decision of a patient and their doctor, not rigid health plan policies. Increasing options, reducing paperwork, and restoring physician authority result in better patient care.” For more information, visitwww.TheNationalCouncil.org.

Last Updated 10/20/2021

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