Step therapy, otherwise known as “fail first” therapy, is a harmful medical protocol whereby insurers require patients, sometimes even those stable on a certain medication, to try and fail medications before agreeing to cover the initial therapy prescribed by the health care provider. Not only are these protocols unnecessary and ill-advised – they are harmful to patients and limit the ability of physicians to provide quality, individualized care.  

The issue is particularly acute for mental health treatment, given the individualized nature of psychiatric medication prescriptions. If mental illnesses go untreated, or are inappropriately treated, a patient’s risk of inpatient hospitalization, persistent or significant disability, or death is heightened. Requiring a patient to first adhere to step therapy protocols, instead of starting or maintaining an appropriate medication the first time, raises the overall costs of care, delays patient stabilization, and risks patient safety. 

Additionally, the risk of suicide attempts and completed suicide increases for patients with any psychiatric disorder, and this risk can increase exponentially for patients who suffer from disorders like depression and anxiety, who are unable to access the antidepressants that can control their symptoms. In 2022, 49,449 Americans died by suicide, the highest number ever recorded. In light of this crisis, and accounting for ongoing stressors associated with the COVID-19 pandemic, now is the time to enable, not constrict, broader access to mental health services. 

Please urge your member of Congress and Senator to support H.R. 2630/S.652 to require health insurance companies to provide clear exemptions to harmful step therapy policies and expedite the timeline in which these are granted.