Bill Text: IL SB0112 | 2011-2012 | 97th General Assembly | Amended
Bill Title: Amends the Illinois Insurance Code. Makes a technical change in a Section concerning the short title.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2013-01-08 - Session Sine Die [SB0112 Detail]
Download: Illinois-2011-SB0112-Amended.html
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1 | AMENDMENT TO SENATE BILL 112
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2 | AMENDMENT NO. ______. Amend Senate Bill 112 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Insurance Code is amended by | ||||||
5 | adding Section 356z.19 as follows:
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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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