Sen. M. Maggie Crotty
Filed: 3/8/2011
 
 

 

 

 
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1
AMENDMENT TO SENATE BILL 112




2    AMENDMENT NO. ______. Amend Senate Bill 112 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.".