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Senate of Pennsylvania
Session of 2019 - 2020 Regular Session


Posted: December 2, 2018 10:27 AM
From: Senator Michele Brooks
To: All Senate members
Subject: Insurance Coverage for Lyme Disease
I am re-introducing the main provisions of legislation championed by former Sen. Stewart Greenleaf to provide insurance coverage for the long-term antibiotic treatment of Lyme disease, if medically necessary and recommended by the patient’s health care provider. Sen. Greenleaf’s bill was Senate Bill 100 of the 2017-2018 session.

Pennsylvania leads the nation in Lyme disease cases, and has held this unenviable distinction for more than seven consecutive years. The number of new cases is growing at an alarming rate. In 2016, 11,443 Lyme disease cases were reported in Pennsylvania, but the Centers for Disease Control (CDC) estimate under-reporting by a factor of 10, projecting occurrence rates, more accurately, in the 100,000s. Small children are at the greatest risk for Lyme disease, and approximately 300,000 Americans are estimated to get Lyme disease every year in the U.S., according to the CDC.

Left untreated or improperly treated, Lyme disease can lead to debilitating symptoms, which include fevers, rash, facial paralysis, arthritis, swollen lymph nodes, muscle and joint aches, severe headaches, irregular heartbeat, memory loss and nerve pain, according to the CDC.

In October of 2017, the Senate Aging and Youth Committee joined with the Health and Human Services Committee in holding a hearing on the progress made on Lyme disease since the release of a Task Force report, mandated by Act 83 of 2014. We found that many of the recommendations from the Task Force were never implemented, and chief among them was insurance coverage for extended treatment. Fortunately, the 2018-2019 budget included $2 million to begin work on implementing some Lyme disease recommendations, but far more needs to be done.

The debate over long-term antibiotic treatment reflects two schools of thought in treatment and diagnosis. The Infectious Disease Society of America’s (IDSA) guidelines recommend short-term antibiotic treatment for Lyme disease, even if symptoms persist. In contrast, the International Lyme and Associated Disease Society (ILADS) guidelines provide for longer-term antibiotic treatment, when symptoms are not cured by shorter-term protocols.

I join many advocates in maintaining that insurers should cover both approaches, both of which are evidence-based, as long as the treating physician informs the patient of all treatment options, risks, and benefits, and the patient provides consent.

A 2013 CDC study found that only 39% of those with Lyme disease were treated using short- term antibiotic recommendations from the IDSA guidelines. The majority were treated for longer periods, more in keeping with the ILADS recommendations.

Under this proposed bill, health insurers would be required to cover the treatment prescribed by their health care practitioner for Lyme disease or related tick-borne illnesses if the diagnosis and treatment plan are documented in the patient's medical record. Treatment plans may include short or longer durations of antibiotic or antimicrobial treatments. Longer-term antibiotic treatment shall not be denied coverage solely because such treatment may be characterized as unproven, experimental, or investigational in nature for the treatment of Lyme and related tick-borne diseases.

The legislation provides that health care professionals have the right to diagnose and prescribe antibiotic therapy for a duration they deem appropriate upon making a clinical diagnosis of Lyme disease or related tick-borne disease. In addition, no health care professional shall be subject to disciplinary action by their licensing board solely because they prescribed longer-term antibiotic therapies for a therapeutic purpose for a patient with Lyme disease or related tick-borne illness. The licensing board retains appropriate monitoring powers to ensure patient safety.

Similar language has been approved in other states (including Rhode Island, New York, Minnesota, Connecticut, Massachusetts, New Jersey, and Vermont) that protects health care professionals from such actions, and also avoids the “chilling effect” such sanctions have had on physicians in diagnosing and treating Lyme disease.

Sen. Greenleaf’s Senate Bill 100 of 2017-2018 session was cosponsored by Senators Scavello, Baker, Hutchinson, Schwank, Farnese, Brewster, Costa, Langerholc, Haywood, Boscola, Rafferty, and Alloway.

Please join me in cosponsoring this legislation. Thank you.

Introduced as SB100