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Budget Summary FY2017

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Outside Section 111
Data Current as of:  8/9/2016

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Lyme Disease Mandated Benefit III

SECTION 111.   Chapter 176A of the General Laws is hereby amended by inserting after section 8II the following section:-

Section 8JJ. .(a) For the purposes of this section, "Long-term antibiotic therapy" and "Lyme disease" shall have the same mean as ascribed to them in section 12DD of chapter 112.

(b) A contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient's symptoms, diagnostic test results, or response to treatment. An experimental drug shall be covered as a long-term antibiotic therapy if it is approved for any indication by the United States Food and Drug Administration; provided, however, that a drug, including an experimental drug, shall be covered for an off-label use in the treatment of Lyme disease if the drug has been approved by the United States Food and Drug Administration.