BOSTON (STATE HOUSE NEWS SERVICE) – Insurers in Massachusetts would receive a new mandate to cover long-term antibiotic therapy for the treatment of Lyme disease under an amendment the House adopted in its $39.5 billion budget bill.
Rep. David Linsky, a Natick Democrat who sponsored the amendment and served on a commission looking into the tick-borne illness, said patients with Lyme disease have gone out of state for treatment or suffered financial hardship when their treatment was not covered.
“Lyme disease is truly an epidemic that continues to spread across the Commonwealth at an alarming rate,” Linsky said in a statement. “This is an important first step in helping to give access to treatment for the thousands who suffer in Massachusetts every year.”
Representatives of the health insurance industry and small businesses said the mandate would disproportionately raise the health care costs of smaller companies without the resources to self-insure. Self-insured companies are regulated federally and not subject to state mandates.
“Legislators think they’re mandating coverage for everybody and they’re not,” National Federation of Independent Business Massachusetts State Director Bill Vernon told the News Service. A former House Republican, Vernon said, “I understand they’re hard to vote against,” but emphasized that large corporations that can self-insure are not subject to state mandates.
Eric Linzer, vice president at the Massachusetts Association of Health Plans, said the Centers for Disease Control and Prevention and others have warned about the efficacy of long-term antibiotic treatment of Lyme disease, and pointed to the amendment’s language prohibiting a denial of coverage “solely because such treatment may be characterized as unproven, experimental, or investigational in nature.”
“From a medical efficacy standpoint this mandate is promoting bad medicine,” Linzer told the News Service. He said, “We’ve certainly raised the concern with what the medical science indicates.”
The House added language to Linsky’s amendment, which was adopted on a voice vote, to sunset the mandate on July 1, 2021.
The Center for Health Information and Analysis in 2014 reported a bill mandating insurance coverage for long-term antibiotic treatment of chronic Lyme disease would have a “negligible” cost of up to 11 cents per year to a typical member’s health insurance premium.
Linzer said the mandate cost would add to the existing $45.75 per-member per-month cost of mandated coverage, and he said health insurance plans already cover treatment of Lyme disease, which typically lasts about 28 days.
“You will get treated for Lyme disease,” said Linzer, who said there may be some variations of plans extending treatment beyond 28 days.
Spread by ticks, untreated Lyme disease can cause arthritis, meningitis and hepatitis, according to the health information center’s report.
“While the majority of Lyme disease patients are successfully treated with a single or double course of antibiotics, especially if treatment begins in the early disease stage, an estimated 10 to 20 percent of patients have symptoms that last months or years after antibiotic treatment, including fatigue and sleep disturbances, muscle and joint pain, and cognitive deficits,” the report said.
The Senate earlier this year sent the House a coverage-mandate bill (S 2137) requiring insurance plans to treat HIV-related lipodystrophy, a debilitating side-effect of the toxic treatments used to treat HIV years ago.