Massachusetts, USA: Insurance Coverage for Lyme Treatment Becomes Law

Alex Elvin, August 11, 2016 6:40 pm

The state legislature has adopted a new bill requiring insurance companies to cover long-term antibiotic treatment of Lyme disease, despite considerable pushback from the medical and health insurance communities, and from Gov. Charlie Baker, who twice remanded the bill in the final weeks before the legislative session closed in July.

In covering the long-term treatment of Lyme disease, insurance companies must now cover experimental drugs as well, including for off-label use, as long as the drugs are approved (for any indication) by the Food and Drug Administration.

Governor Baker, a former health insurance executive, vetoed the bill in late July, citing a lack of medical evidence to support the mandate, and raising concerns about the coverage of experimental drugs. But the House and Senate held fast to their original language and adopted the bill almost unanimously in the last two days of the session.

Chronic Lyme has been the subject of much debate in the medical community, with two general camps emerging in the last 10 years. One argues for the treatment of Lyme symptoms for however long they last, while the other argues that long-term antibiotic treatment is ineffective and unproven to work. The new bill, which received final approval by the House on July 31, builds on an existing law that allows doctors to prescribe long-term treatment without censure.

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