PA Bill Targets Insurance Barriers As Mental Health Drug Denials Rise

Health advocates are concerned about growing insurance barriers and they support a Pennsylvania bill designed to make mental healthcare more accessible.

House Bill 1519 would prohibit insurers from requiring prior authorization for medications used to treat mental illness. Research from the Johns Hopkins Bloomberg School of Public Health found rejection rates for some brand-name medications rose 67% between 2018 and 2024.

Rep. Steve Malagari, D-Montgomery, the bill's sponsor, said interruptions stemming from insurance industry practices can mean missing a critical chance to help a patient.

"It is a stopgap in the insurance industry to control costs but also to guide patients down a path of what they deem as proper protocol within a treatment plan. However, with serious mental health, sometimes you only get one opportunity to help someone," Malagari pointed out.

The study found nearly one-third of initial prescription fill attempts were rejected because of formulary exclusions or insurers’ utilization-management requirements, such as rules specifying patients test out other drug treatments.

Malagari, who was seeking reelection this fall, will meet with the current legislature next week. His bill is in the House Insurance Committee, with no floor vote scheduled. Similar legislative approaches in Pennsylvania encountered pushback.

Samantha Heckel, spokesperson for the Patients Before Paperwork Coalition, said its members support the legislation. She added one of their main priorities is eliminating prior authorization and step therapy, also known as fail first. Echoing effects from the Johns Hopkins research, she noted step therapy requires patients to try a preferred medication before accessing the medication originally prescribed.

"Delays in these medications can contribute to worsening symptoms, relapse, hospitalization and the need for more intensive care. People experiencing serious mental illness should not have to get worse before accessing the treatment their provider believes is appropriate," Heckel contended.

Don Hannaford, vice president of public policy for the mental health nonprofit Rural Minds, said they are working with the coalition to make it easier for people to secure mental health treatment. He added they recently launched a national program oriented toward mental wellness for youth in rural America, because of the significant incidence of death by suicide. He explained data from the Rural Health Information Hub underscored the importance of the initiative.

"Youth 15 to 19 are 75% more likely to die by suicide than anywhere else," Hannaford emphasized. "It's a multifaceted program. We have other programs that we've had related to isolation, postpartum depression."

They offer a range of services to reach the 46 million Americans living in smaller communities.

Pennsylvania's 2026-27 state budget includes $15 million in new funding for behavioral health crisis services, with $10 million for the 988 Suicide and Crisis Lifeline and the remainder for walk-in crisis stabilization centers.