Rep. Lou Lang
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AMENDMENT TO HOUSE BILL 62
AMENDMENT NO. ______. Amend House Bill 62 by replacing
everything after the enacting clause with the following:
The Illinois Insurance Code is amended by
adding Section 356z.19 as follows:
(215 ILCS 5/356z.19 new)
Phototherapy treatment for psoriasis.
(a) The General Assembly finds as follows:
(1) Psoriasis is a non-contagious, chronic,
inflammatory, painful, and often disfiguring and disabling
autoimmune disease for which there is no cure.
Approximately 333,000 Illinois residents are affected by
psoriasis, the most prevalent autoimmune disease in this
country. It is a systemic disease that is connected with an
elevated risk for a range of other serious, chronic, and
life-threatening comorbid conditions, including
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cardiovascular disease, diabetes, hypertension, and
stroke. Up to 30% of people with psoriasis also develop
potentially disabling psoriatic arthritis.
(2) Psoriasis is a lifelong chronic disease and
requires timely and appropriate medical care. Lack of
appropriate treatment for psoriasis can result in serious
adverse impacts to functioning, including loss of
mobility, pain, isolation, and depression and may
contribute to comorbid conditions.
(3) Phototherapy (ultraviolet light therapy) is a
safe, effective, and commonly prescribed first-line
treatment for psoriasis. Phototherapy is treatment
exposing the skin to an artificial ultraviolet light source
for a set length of time on a regular schedule.
(4) Phototherapy is a critical treatment option for
patients who are prevented from taking other medications
because of conditions such as pregnancy, infection, or
malignancy. It is also an important treatment used in
combination with other medications.
(5) A typical start-up regimen for phototherapy is 3
treatment visits per week, for 8 to 12 weeks. Long-term
maintenance regimens are usually required. Surveys of
psoriasis patients indicate approximately 18 % use
phototherapy to treat their psoriasis, or about 60,000
people in this State.
(6) Other prescribed treatments for psoriasis, such as
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systemic or biologic medications, while important options
for some patients can have serious side effects, including
death, liver toxicity, kidney failure, cancer, birth
defects, and infections such as tuberculosis.
(7) Phototherapy is a relatively inexpensive
treatment, compared to other treatment
psoriasis such as systemic or biologic medications. The
annual cost to the health care system for phototherapy is
approximately one-seventh the cost of some other treatment
(8) Despite its relatively economical cost, very
substantial copayments for phototherapy
are a barrier to
accessing care for patients who need this safe and
effective option to treat their disease and live a normal
life. As a result, patients either opt out of treatment
entirely or prematurely move to more expensive and
sometimes riskier therapies.
(9) While a physician may likely prescribe a course of
treatment for phototherapy lasting
many months, the
patient is charged a copayment for each individual
phototherapy treatment throughout the course of the
(10) Prescriptions for other treatments can have much
lower out-of-pocket costs under pharmaceutical
prescription plans than phototherapy, which is billed as an
office procedure, creating financial difficulty for
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patients for whom phototherapy might otherwise be the
preferred treatment option. Generally, prescriptions for
medications carry one fixed monthly copayment, whereas
phototherapy may require 12 or more copayments in one
(11) The General Assembly recognizes the importance of
requiring, where shown to be
medically necessary, rational
and economical insurance coverage that encourages and
incentivizes healthy, preventive, and cost-effective
decision making by both physicians and patients.
(b) With regard to an insured who is prescribed
phototherapy treatment for psoriasis from a physician, a
physician may determine whether, in the physician's opinion,
the failure of a patient to undergo the prescribed course of
phototherapy treatment would increase the likelihood that the
patient will need to be shifted to a more costly course of
treatment. Insurance plans may seek physician certification
that the factor described in this subsection (b) exists.
(c) In those cases where the physician has made the
determination described in subsection (b) of this Section, no
group or individual health insurer shall (i) charge a copayment
for a prescribed course of phototherapy treatment that exceeds
50% of the first phototherapy treatment or (ii) charge
copayments for additional phototherapy treatments performed
under the same course of treatment.