Urge your State Legislators to Prohibit Fail-First Protocols in Maryland - HB382

Some insurers use "fail-first" (also known as "step therapy") policies that require a person to try one or more insurer-preferred medications unsuccessfully before they can receive coverage for the medication their doctor recommends. The process of failing on another medication can take weeks or months. While this may be a mere annoyance for some health conditions, for serious health conditions like mental illness, it can have life-altering or even life-threatening consequences for the patient.

Although step therapy is often promoted as a cost-saving strategy, policies that restrict access to appropriate medications can lead to negative outcomes, including emergency department visits, hospitalizations, homelessness, or unnecessary involvement with the criminal justice system.
Fail-first protocols result in patients being unable to access the treatments they need when they need them. Physicians can request exceptions to these protocols, but insurers may not respond promptly, causing further delays in treatment. Insurers should not interfere with the decision-making process between a mental healthcare provider and their patient.

For individuals taking medications for mental health conditions, a one-size-fits-all approach does not work. Mental health medications affect people — even those with the same diagnosis — in different ways, with varying levels of effectiveness and potential side effects. Because of this, it is critical that individuals have access to the medication that works best for them.

The cost to individuals, families, and communities when a person with mental illness must fail on a medication before receiving the one they need is too high. Maryland’s policies should protect, not jeopardize, access to mental health medications. Fail-first protocols put the safety of people with mental health conditions at risk.

House Bill 382 would eliminate fail-first protocols for individuals living with bipolar disorder, schizophrenia spectrum disorders, major depression, post-traumatic stress disorder, and movement disorders associated with the treatment of serious mental illness. I urge you to vote YES on HB382.