In the hailstorm of criticisms over health care costs, we hear every now and again about the costs associated with treating mental health. Since, like the rest of health care, the great innovations of the last 50 years have come from the pharmaceutical industry, what we are predominantly talking about is the cost of drugs.

The push in recent years has been towards something called “step therapy”, the practice by which insurers (or Medicaid) require patients to try a number of less-expensive drugs before they will cover the medication recommended by their doctor. The idea is simple, and designed to reign in the costs of treatment – rather than presumptively default to the most expensive drug on the market, try a few less-costly options first. On its face, not a bad idea; if a Honda gets the job done, why opt first for the Cadillac?

But as the French say, “une fausse idee claire”; a terrific idea that doesn’t work – at least not universally, or in the case of someone with a severe mental illness (SMI).

The key to step therapy is that the patient’s treatment has to fail however many times before the medication which their doctor actually recommends is finally approved. Now, that may be acceptable for certain conditions – say, erectile dysfunction or acne – where, sure, a failed treatment may somewhat diminish one’s quality of life, but not result in potentially catastrophic consequences. It is a rather different story when talking about congenital heart failure.

It is also a different story when talking about serious mental illness. Consider: what happens to a person with schizophrenia, or severe depression, or paranoia, while their treatment is failing? Are they able to keep functioning in society? Keep a job? Take care of themselves or their children? Interact responsibly with others? Stay clean and sober? The fentanyl-laced homeless encampments we keep seeing pop up around the city are full of examples of failed mental health treatment.

The discussion takes an even more ominous turn when one considers the possibility of harm being done to others. Every time there is a mass shooting we claw at each other over the marginal issues. We despair of the instrument by which to identify, before the fact, those who pose the most danger to society. What we DO have are effective mental health treatments available to those diagnosed with SMI’s, provided they have access to it.

There are a couple measures working their way through the state legislature that seek to increase patient access to mental health medication, which deserve consideration.

What HB1130 does is to limit the number of fails before a patient in the commercial market – i.e. small group and individual plans – can receive the medically recommended treatment. It says, reasonably, that a step therapy protocol for SMI’s cannot try more than one other drug before being covered for the one the doctor’s training and expertise prescribes. It also streamlines the process by which new FDA-approved SMI medications are made available to Medicaid patients by requiring the Colorado Department of Health Care Policy and Financing (the adorably acronymed HCPF) to review any such drug for inclusion in the Medicaid Preferred Drug List within 90 days of the FDA’s approval.

SB33 applies a similar logic to the Medicaid side of the house that HB1130 does to the commercial insurance market. For Medicaid recipients with SMI, SB33 removes virtually any barrier to existing treatment, including step therapy and pre-authorization. This latter element recognizes not only that doctors are not paid to do superfluous paperwork, but also that while patients with, for instance, heart conditions or arthritis maybe willing to do whatever they must to get the treatment they need – including calling their doctor 5 times a day to get the requisite authorizations – someone with severe depression, who struggles desperately to face the simplest challenges of life, is far less likely to negotiate such obstacles.

For the fiscally-minded amongst us, there are economic considerations as well. An analysis of the impact of step therapy on patients diagnosed with Major Depression Disorder in Florida by the Regional Economic Consulting Group found that the practice increased medical, workplace, suicide, and tax-related costs in the state to the tune of $271.5 million.

It is understandable why the insurance industry pursues remedies such as step therapy. It is not due to some inherent greedy evil on their part; they do it because so many lamentable decisions of government – copious coverage mandates, price controls and the like – have forced them to grasp at whatever straws they can. Sadly, this is the wrong one on which to grasp.

Colorado’s state legislators ought to support these measures, for, if for no other reason, in showing concern for those with serious mental illness they show concern for a place which, but by the grace of God, go any of us.