Electronic Spring 2024 | Issue 58

State Legislative Article

By: Mark Peysakhovich, IPS Legislative Consultant

IPS joins fight to end prior authorization and other utilization management controls in Illinois

On March 7, 2024, IPS President Andrew Lancia, MD, DFAPA, FACLP, joined other health care providers and advocates for a hearing of the House Mental Health and Addiction Committee and a news conference in Springfield, to support House Bill 2456 and Senate Bill 1636. This legislation, sponsored by Rep. Lindsey LaPointe and Sen. Sara Feigenholtz, seeks to remove prior authorization and other medication utilization management controls for Illinois Medicaid patients suffering from serious mental illness, including bipolar disorder, depression, and schizophrenia.

"We applaud Rep. LaPointe, Sen. Feigenholtz, and the Governor for putting a spotlight on the dangers to patients of delayed mental health care and treatment because of prior authorization and the impact on our workforce and the time it takes away to treat patients,” said Dr. Lancia. “Our hope is the legislature and Governor will consider prohibiting prior authorization and step therapy in the outpatient setting, especially Medicaid. We should be fighting our patients’ illnesses, not their insurance companies."

Utilization controls such as prior authorization and step therapy interfere in the patient-doctor relationship and often create insurmountable obstacles for vulnerable patients. Medicaid patients, in particular, face many bureaucratic barriers to receiving the medications prescribed by their physicians. The need for preauthorization stunts access to continuing care while also burdening our overtaxed behavioral healthcare workforce.

If passed, House Bill 2456/Senate Bill 1636 would allow for more seamless care following institutionalization and hospitalization. Over 15 states have removed prior authorization and/or step therapy barriers in their Medicaid programs. There is currently no research demonstrating that prior authorization/step therapy requirements have any benefits for those living with serious mental illness.

“We must ensure our low-income Illinoisians who have been treated in a hospital setting, once stabilized, can leave the hospital with the comfort of seamlessly accessing their life-saving treatment and medications in their daily life,” said LaPointe. “When you are one of the 403,000 Illinoisans suffering from serious mental illness, such as bipolar disorder, depression, and schizophrenia, the delay in days or even weeks because of prior authorization is a matter of life and death. We must fix this for patients.”

Please contact your state legislators today! Urge your State Representative to co-sponsor and support House Bill 2456. And urge your State Senator to co-sponsor and support Senate Bill 1636.