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 | 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 |
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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 | 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. ".
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