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Full Text of HB0062  97th General Assembly

HB0062ham001 97TH GENERAL ASSEMBLY

Rep. Lou Lang

Filed: 3/3/2011

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 62

2    AMENDMENT NO. ______. Amend House Bill 62 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5adding 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

 

 

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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

 

 

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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

 

 

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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
12phototherapy treatment for psoriasis from a physician, a
13physician may determine whether, in the physician's opinion,
14the failure of a patient to undergo the prescribed course of
15phototherapy treatment would increase the likelihood that the
16patient will need to be shifted to a more costly course of
17treatment. Insurance plans may seek physician certification
18that the factor described in this subsection (b) exists.
19    (c) In those cases where the physician has made the
20determination described in subsection (b) of this Section, no
21group or individual health insurer shall (i) charge a copayment
22for a prescribed course of phototherapy treatment that exceeds
2350% of the first phototherapy treatment or (ii) charge
24copayments for additional phototherapy treatments performed
25under the same course of treatment.".