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Senate of Pennsylvania
Session of 2021 - 2022 Regular Session


Posted: December 1, 2020 09:04 PM
From: Senator Michele Brooks and Sen. Doug Mastriano
To: All Senate members
Subject: Insurance Coverage for More Comprehensive Antibiotic Treatment of Lyme Disease
We are re-introducing legislation to ensure insurance coverage for more comprehensive antibiotic treatment of Lyme disease. This legislation was previously Senate Bill 100 of the 2019-2020 Session.

Pennsylvania leads the nation in Lyme disease cases. In 2018, 10,208 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.  From 2000 to 2018, there have been 106,718 confirmed Lyme disease cases in Pennsylvania, but again, due to the fact that the CDC’s data only represents confirmed cases, the actual quantity of Lyme disease cases may be far greater, possibly over 1,000,000.

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.  But, if treated within the first 30 days, 10% or less of patients will progress to late state.  If after 30 days, 60% of patients progress to late stage.

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.

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.

Senate Bill 100 was previously cosponsored by Senators Scavello, Regan, Langerholc, Argall, Fontana, Schwank, Brewster, J. Ward, Dinniman, Costa, Laughlin, Alloway, Haywood, Killion, Vogel, Collett, Street, Blake, Muth, Aument, Boscola, K. Ward and Mastriano.

We hope you join us in cosponsoring this important legislation. Thank you.

Introduced as SB100