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Lyme patients get good news
A bill mandates comprehensive care by health insurers.
07/04/2003
BY JENNIFER D. JORDAN Journal Staff Writer

In a move that surprised even ardent supporters, the General Assembly passed a bill just before 11 p.m. Wednesday requiring health insurance companies to cover long-term intravenous antibiotic treatment for Lyme-disease patients.
Rhode Island, which has the second-highest rate of the tick-borne illness in the country, is the first state to mandate such comprehensive coverage, Lyme-disease activists say.
"This is a miracle," said Lisa Larisa, president of the Rhode Island chapter of the Lyme Disease Association, who lobbied lawmakers until late into the night. "It is a huge, huge step forward."
Currently, most health insurance companies now cover only four to six weeks of intravenous treatment and say that there's little scientific evidence that prolonged antibiotic use helps.
"It is unfortunate that our entire membership is being asked to pay for treatment that has not been proven effective," said Scott Fraser, spokesman for Blue Cross & Blue Shield of Rhode Island, the state's largest health insurer. "There's no limit to this treatment, and I can foresee many more customers and doctors alike considering it now. I'm sure we'll see an increase in numbers, and that has to be reflected in premiums."
But Lyme-disease activists say long-term antibiotics do help some patients.
"As a result of these laws," said Pat Smith, president of the national Lyme Disease Association, "I think we'll start seeing fewer people becoming debilitated by the illness, because they'll get appropriate medicine more quickly." Last year, lawmakers passed a law that protects doctors who prescribe long-term antibiotic treatment.
Last year, about 40 people requested long-term treatment and about 15 pushed through to the final level of appeal to have their intravenous treatment extended, but only one case was successful, Fraser said.
The company estimates intravenous antibiotic treatment costs about $125 a day; antibiotic pills cost $1 a day.
Emily Morton, 16, of East Greenwich, was one patient who was rejected. Her doctor helped arrange for her to get free medicine, and for the last nine months, her family has helped her administer the drugs through a tube from her arm into her heart. She said she feels better and hopes to be off the IV by the time she'd be eligible for the new coverage, in January.
But her parents say they are still relieved lawmakers passed the bill, even if their daughter won't directly benefit.
"This is not an issue that is going to go away," said Paul Morton, Emily's father. "I believe the Rhode Island legislature has taken a stand that will force the insurance companies to do the right thing."
The bill, sponsored by state Rep. Raymond E. Gallison Jr., D-Bristol, and state Sen. Michael J. Damiani, D-East Providence, almost fell apart several times this week, as health insurance companies proposed amendments that would limit the length of treatment to 12 weeks and narrow the type of doctors who could prescribe intravenous antibiotics, Gallison said.
In the end, a compromise was reached and a sunset provision was added. The bill will stay in effect only until Dec. 31, 2004, although patients whose policies are renewed next summer will be eligible for a full year of treatment, into 2005, said Joseph S. Larisa Jr., a consultant and former chief of staff for Gov. Lincoln C. Almond. Larisa, who is also Lisa Larisa's brother, helped organize last year's Lyme disease commission. He said he isn't discouraged by the temporary nature of the bill.
"What we needed desperately was to get a law on the books that was binding," Larisa said. "Now that it's in law, we're hoping the education of the public and of doctors continues, and we hope people might not need this kind of treatment in the future."
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