Illinois could ban prior authorization for mental health prescriptions helping Medicaid patients

SPRINGFIELD, Ill. (WAND) — Gov. JB Pritzker announced last month that he wants Illinois to become the first state in the nation to ban prior authorization for in-patient adult and children's mental health care.

However, Democrats and Republicans in the General Assembly would also like to ban prior authorization for psychotropic drugs helping people with serious mental illnesses who are on Medicaid. 

Rep. Lindsey LaPointe (D-Chicago) told the House Mental Health & Addiction Committee Thursday that a quarter of the state's behavioral health care providers pull themselves out of insurance networks because they don't want to waste time with prior authorization.

"We are at an acute moment where mental health needs are higher than they've every been," LaPointe said. "People's willingness to seek treatment are higher than they've ever been. And yet, our behavioral healthcare workforce, including our doctors and psychiatrists, is more stretched than it has ever been."

Advocates from the National Alliance on Mental Illness Chicago said many patients stop taking their medications cold turkey and suffer from withdrawal symptoms due to endless delays from prior authorization. 

House Bill 2456 would ban prior authorization mandates under fee-for-service and managed care medical assistance programs on any FDA-approved prescription drug used for mental health treatment. 

Many behavioral health providers see their patients wait months to get their critical medications. That often leads to patients spending long periods of time in the hospital or self harm.

"Please allow doctors like me to fight illness, to spend our time diagnosing and treating as we were educated to do, not spending time navigating prior authorization and fighting insurance companies," said Dr. Andrew Lancia, President of the Illinois Psychiatric Society. 

Sponsors and advocates say eliminating prior authorization will directly improve equity in mental healthcare. LaPointe said Illinois cannot have a two-tiered healthcare and mental healthcare system anymore. 

"Making sure everyone in Illinois has seamless access to care is a bipartisan issue," LaPointe said. "It something that people all across the state care about. There's just a ton of human and political support to get rid of these barriers so people can get the care they need which also saves money."

House Bill 2456 was filed during the 2023 spring session, but sponsors hope it will gain strong bipartisan support this spring.

"When you have a patient who could be a harm to himself or others, we have a full population of people that could be effected if a patient does no get acute mental health care and the correct care quickly," said Rep. Bill Hauter (R-Morton). "It's very important that we take care of not only that patient, but also the population that is at risk." 

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