Insurance companies should not overrule doctors in mental health treatment

Entering into a new legislative session, lawmakers like myself often reflect on what we have accomplished, and what we still hope to achieve. One thing on my mind, and which I’m sure is on the mind of many of my colleagues, is how we’re going to combat Colorado’s worsening mental health crisis.

Since being sworn into office in 2017, one of my top legislative priorities has been to implement better mental health care, coverage, and access for Coloradoans suffering from a mental illness. According to the Kaiser Family Foundation, nearly one third of Coloradoans experienced symptoms of anxiety or depression in 2021. And in 2022, a report by Mental Health America found that 23% of Colorado adults suffer from a mental illness.

The problem lies in the fact that our treatments for mental illness have been largely unchanged for decades, with most people being prescribed drugs that were approved by the FDA in the last century. Meanwhile, rates of mental illness have skyrocketed in the past decade. According to the CDC, one in five Americans in 2020 received treatment for their mental health — with 16% being prescribed medication.

When someone acknowledges that their mental well-being is declining and that they need treatment, the expectation is that they meet with a provider and be placed on a treatment plan best tailored to their needs. Unfortunately, it’s not that simple, at least not in Colorado. Barriers impeding timely access to cutting-edge and physician-recommended psychiatric treatments continue to regress our state’s healthcare system and blockade pathways to wellness for our state’s patients.

One such barrier is step therapy. Step therapy is a common insurance practice where before a patient can be prescribed a medication their provider thinks would be the best treatment, they must first sample other, less-expensive drugs; insurance will not cover the provider-recommended treatment until cheaper alternatives are tried first. The treatment the provider recommends may be more expensive, but just like physical health, I trust my medical provider to make the best and most informed decisions about what medicines I should take.

While some argue that step therapy can lead to lower costs for insurance providers because some patients may find that alternative, insurance-provided drugs treat their condition, the fact remains that the detriments of this insurance practice unduly harm patients who do not find success – especially those who suffer serious mental illnesses, or SMIs. Having to prove that a medication does not treat one’s symptoms not only prolongs the time these symptoms are felt, but also introduces a host of new, potentially worse side effects caused by medications that weren’t .caused by medications that weren’t the principal recommendation of the medical professional.

Untreated or inadequately treated mental illnesses also pose a serious impediment to our economic growth. A study published by the National Library of Medicine found that major depressive disorder (MDD), among the most common SMI’s, is associated with significant lost work performance, equating to 27 excess lost workdays annually per worker suffering from this ailment.

The facts speak for themselves – when over a quarter of the state has a mental illness, and a third have symptoms often associated with a mental illness, we need to be doing more to solve this problem — more than just spreading awareness. These facts demand solutions, strong solutions which can only be achieved through legislation.

This is why in 2023, I will be supporting legislative efforts that reform unnecessary and time-consuming processes like step therapy in the mental health field. Facilitating treatment access to provider-recommended medications for those suffering from SMIs will not only break down stigmas and strengthen doctor-patient trust; it will improve the lives of those who need our help the most.

It’s 2023 – it’s time to modernize the way we treat mental health.

Dafna Michaelson Jenet represents District 32 in the Colorado State House of Representatives, and serves as Chair of the House Public and Behavioral Health and Human Services Committee.

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