|
Sen. M. Maggie Crotty
Filed: 3/8/2011
| | 09700SB0112sam001 | | LRB097 06382 RPM 51799 a |
|
|
1 | | AMENDMENT TO SENATE BILL 112
|
2 | | AMENDMENT NO. ______. Amend Senate Bill 112 by replacing |
3 | | everything after the enacting clause with the following:
|
4 | | "Section 5. The Illinois Insurance Code is amended by |
5 | | adding Section 356z.19 as follows: |
6 | | (215 ILCS 5/356z.19 new) |
7 | | Sec. 356z.19. Phototherapy treatment for psoriasis. |
8 | | (a) The General Assembly finds as follows: |
9 | | (1) Psoriasis is a non-contagious, chronic, |
10 | | inflammatory, painful, and often disfiguring and disabling |
11 | | autoimmune disease for which there is no cure. |
12 | | Approximately 333,000 Illinois residents are affected by |
13 | | psoriasis, the most prevalent autoimmune disease in this |
14 | | country. It is a systemic disease that is connected with an |
15 | | elevated risk for a range of other serious, chronic, and |
16 | | life-threatening comorbid conditions, including |
|
| | 09700SB0112sam001 | - 2 - | LRB097 06382 RPM 51799 a |
|
|
1 | | cardiovascular disease, diabetes, hypertension, and |
2 | | stroke. Up to 30% of people with psoriasis also develop |
3 | | potentially disabling psoriatic arthritis. |
4 | | (2) Psoriasis is a lifelong chronic disease and |
5 | | requires timely and appropriate medical care. Lack of |
6 | | appropriate treatment for psoriasis can result in serious |
7 | | adverse impacts to functioning, including loss of |
8 | | mobility, pain, isolation, and depression and may |
9 | | contribute to comorbid conditions. |
10 | | (3) Phototherapy (ultraviolet light therapy) is a |
11 | | safe, effective, and commonly prescribed first-line |
12 | | treatment for psoriasis. Phototherapy is treatment |
13 | | exposing the skin to an artificial ultraviolet light source |
14 | | for a set length of time on a regular schedule. |
15 | | (4) Phototherapy is a critical treatment option for |
16 | | patients who are prevented from taking other medications |
17 | | because of conditions such as pregnancy, infection, or |
18 | | malignancy. It is also an important treatment used in |
19 | | combination with other medications. |
20 | | (5) A typical start-up regimen for phototherapy is 3 |
21 | | treatment visits per week, for 8 to 12 weeks. Long-term |
22 | | maintenance regimens are usually required. Surveys of |
23 | | psoriasis patients indicate approximately 18 % use |
24 | | phototherapy to treat their psoriasis, or about 60,000 |
25 | | people in this State. |
26 | | (6) Other prescribed treatments for psoriasis, such as |
|
| | 09700SB0112sam001 | - 3 - | LRB097 06382 RPM 51799 a |
|
|
1 | | systemic or biologic medications, while important options |
2 | | for some patients can have serious side effects, including |
3 | | death, liver toxicity, kidney failure, cancer, birth |
4 | | defects, and infections such as tuberculosis. |
5 | | (7) Phototherapy is a relatively inexpensive |
6 | | treatment, compared to other treatment
options for |
7 | | psoriasis such as systemic or biologic medications. The |
8 | | annual cost to the health care system for phototherapy is |
9 | | approximately one-seventh the cost of some other treatment |
10 | | options. |
11 | | (8) Despite its relatively economical cost, very |
12 | | substantial copayments for phototherapy
are a barrier to |
13 | | accessing care for patients who need this safe and |
14 | | effective option to treat their disease and live a normal |
15 | | life. As a result, patients either opt out of treatment |
16 | | entirely or prematurely move to more expensive and |
17 | | sometimes riskier therapies. |
18 | | (9) While a physician may likely prescribe a course of |
19 | | treatment for phototherapy lasting
many months, the |
20 | | patient is charged a copayment for each individual |
21 | | phototherapy treatment throughout the course of the |
22 | | treatment. |
23 | | (10) Prescriptions for other treatments can have much |
24 | | lower out-of-pocket costs under pharmaceutical |
25 | | prescription plans than phototherapy, which is billed as an |
26 | | office procedure, creating financial difficulty for |
|
| | 09700SB0112sam001 | - 4 - | LRB097 06382 RPM 51799 a |
|
|
1 | | patients for whom phototherapy might otherwise be the |
2 | | preferred treatment option. Generally, prescriptions for |
3 | | medications carry one fixed monthly copayment, whereas |
4 | | phototherapy may require 12 or more copayments in one |
5 | | month. |
6 | | (11) The General Assembly recognizes the importance of |
7 | | requiring, where shown to be
medically necessary, rational |
8 | | and economical insurance coverage that encourages and |
9 | | incentivizes healthy, preventive, and cost-effective |
10 | | decision making by both physicians and patients. |
11 | | (b) With regard to an insured who is prescribed |
12 | | phototherapy treatment for psoriasis from a physician, a |
13 | | physician may determine whether, in the physician's opinion, |
14 | | the failure of a patient to undergo the prescribed course of |
15 | | phototherapy treatment would increase the likelihood that the |
16 | | patient will need to be shifted to a more costly course of |
17 | | treatment. Insurance plans may seek physician certification |
18 | | that the factor described in this subsection (b) exists. |
19 | | (c) In those cases where the physician has made the |
20 | | determination described in subsection (b) of this Section, no |
21 | | group or individual health insurer shall (i) charge a copayment |
22 | | for a prescribed course of phototherapy treatment that exceeds |
23 | | 50% of the first phototherapy treatment or (ii) charge |
24 | | copayments for additional phototherapy treatments performed |
25 | | under the same course of treatment. ".
|