House Bill 105: Step Therapy Legislation

Step therapy protocols are a mechanism by which health insurance companies require patients to try one or more prescriptions drugs before coverage is provided for the actual drug prescribed by the patient’s health care provider. This Act creates a Step Therapy Exception Process whereby patients who are required by their insurance company to go through step therapy protocols can, under certain circumstances, bypass step therapy to obtain the initially-prescribed medication. This Act does not apply to state or federal governmental plans.

NAMI Delaware supports HB 105

As a grassroots organization representing families and individuals affected by mental illness in the First State, NAMI Delaware is dedicated to improving the lives of those we serve. Because we believe Delawareans should have access to effective, efficient, and affordable health care, we have joined the Delaware Step Therapy Coalition in support of HB 105. This bill creates common sense reforms for all medical patients in Delaware, and guarantees, access to a clear process for an exception to step therapy when medically appropriate.

Step therapy, known as “fail first,” is used to control costs by insurers, but as an economic solution, it is short sighted. For someone with a mental illness, fail first treatment may not only be life-threatening, it may lead to an increase in illness acuity, resulting in much higher costs for hospitalizations and interventions. The dollars saved using less expensive fail first treatment would hardly measure up to the exorbitant costs of treating an individual with more acute mental illness. Medical professionals, not insurers, should be making decisions about the best treatments for their patients.

While all medical patients deserve the benefits of HB 105, those who live with mental illness experience an additional challenge that makes this bill especially important. Not only do they live with chronic health symptoms that can be debilitating and affect their ability to live and work independently, they have an added obstacle: their illnesses are invisible. Along with their symptoms and the impact their illness brings to their lives, individuals who experience mental illness must first overcome the stigma associated with their condition just to begin treatment at all. More than half of those who experience a mental illness never seek treatment, and if they do, they wait an average of 10 years before doing so.

With the existing step therapy procedures in place, those courageous individuals who are able to overcome the stigma of mental illness and seek treatment for their chronic, yet invisible condition, may then face the added burden of time and discomfort due to step therapy before having a chance to find actual recovery. If they waited 10 years to seek treatment, must they wait even longer because insurers would like to save some money?

Please support HB 105 and ensure that the medical providers of all Delawareans living with chronic illnesses, invisible or not, are able to provide the best treatments for their patients without requiring them to endure less expensive, yet ineffective, or even harmful treatments first.