Tuesday, May 5, 2026

Harabedian Targets ‘Fail First’ Insurance Rules for Mental Health Medications

The Pasadena assemblymember’s AB 1970 would ban step therapy requirements for patients with serious mental illness

When a doctor prescribes medication for schizophrenia or severe depression, the patient’s insurer can override that choice — requiring the patient to first try a cheaper drug, fail on it, and only then receive the original prescription. Assemblymember John Harabedian wants to end that practice for Californians with serious mental illness.

Harabedian, a Pasadena Democrat who represents the 41st Assembly District including Pasadena and Altadena and serves on the Assembly Insurance Committee, introduced AB 1970 earlier this year.

The bill would prohibit health plans and insurers from imposing step therapy — commonly called “fail first” policies — on prescription drugs used to treat serious mental illness and substance use disorders, according to an analysis by the California Health Benefits Review Program. If enacted, the prohibition would take effect for contracts issued or renewed on or after January 1, 2027. The ban would not apply in cases where the FDA’s own labeling requires that a patient take a prior medication first.

The assemblymember highlighted the legislation in a statement issued May 4 by his office to mark Mental Health Awareness Month, whose 2026 national theme is “More Good Days, Together.”

“Although May marks the beginning of Mental Health Awareness month, merely spreading awareness is not enough,” Harabedian said in the statement. “We must continue taking action by advancing meaningful policies that remove unnecessary barriers to care and ultimately reduce stigma around this topic.”

Under step therapy protocols, patients must try an insurer-preferred medication and demonstrate it is ineffective before their plan will cover the treatment their doctor initially prescribed. For patients managing conditions such as bipolar disorder or substance use disorders, the delays can lead to hospitalization and crisis, according to the CHBRP analysis of the bill.

The legislation is part of a broader national movement. Illinois banned step therapy for health plans effective January 2026, and at least seven other states have introduced similar measures this year, according to the CHBRP report.

For Harabedian, who also chairs the Joint Legislative Audit Committee, the bill extends his focus on mental health access for constituents affected by the January 2025 Eaton Fire, which devastated Altadena. The fire, the second-most-destructive in California history according to the Pasadena Community Foundation, killed at least 31 people and destroyed roughly 16,000 structures across Altadena and Pacific Palisades. Data from the California Parent & Youth Helpline after the fires showed that 62% of all calls related to mental and behavioral health needs came from Southern California, according to Harabedian’s office.

More than 16 months later, the Los Angeles County Department of Mental Health continues to operate a walk-in behavioral health center at 540 W. Woodbury Road in Altadena through June 2026, funded through a federal SAMHSA emergency grant. The emotional toll continues to surface long after the flames.

“The emotional trauma after the fires can take several months to set in,” said Julie Anne Swayze, director of advancement and institutional giving at Foothill Unity Center, which received an Eaton Fire relief grant from the Pasadena Community Foundation. “We are now seeing clients who are experiencing depression due to the everyday struggles of figuring out the next steps in their lives.”

Last year, Harabedian and Assembly Speaker Robert Rivas introduced AB 1032, the Wildfire Trauma Recovery and Resiliency Act, which would have required insurers to cover 12 additional behavioral health visits — on top of existing plan benefits — for wildfire-affected residents. Governor Newsom vetoed the measure in October 2025. Harabedian also worked alongside legislative colleagues to approve more than $2.5 billion in emergency wildfire relief, according to his office. In his statement, Harabedian said he looks forward to working with the governor and stakeholders to continue pursuing wildfire-related mental health coverage.

In California, an estimated 1.2 million adults live with serious mental illness, according to NAMI California. Roughly half of all adults with mental health conditions nationally do not receive treatment, and the average gap between when symptoms begin and when a person first receives care is about 11 years, according to the National Alliance on Mental Illness.

Harabedian represents a district that spans from Pasadena and Altadena east through Sierra Madre, Monrovia, Claremont, and into portions of Rancho Cucamonga and Upland. His district office is at 257 S. Fair Oaks Ave., Suite 210, in Pasadena.

Residents experiencing mental health challenges related to the Eaton Fire can reach the LA County fire support line at (833) 659-0600.

On the Assembly floor and in his district, the question Harabedian keeps returning to is the same one facing thousands of his constituents: whether getting help should require failing first.