Bill > H4491

This bill mandates that insurance policies, contracts, agreements, plans, and certificates of insurance issued or renewed in the Commonwealth must provide coverage for long-term antibiotic therapy for patients diagnosed with Lyme disease, provided it is deemed medically necessary by a licensed physician based on a thorough evaluation of the patient's symptoms, diagnostic tests, or response to treatment. This coverage requirement extends to experimental drugs if they are approved by the U.S. Food and Drug Administration (FDA) for any use, and even for off-label uses in treating Lyme disease if the drug itself has been approved by the FDA. The bill defines "Lyme disease" and "long-term antibiotic therapy" by referencing existing definitions in another section of Massachusetts law (section 12DD of chapter 112). These provisions are applied across various types of health coverage, including medical expense coverage, hospital service plans, medical service agreements, and health maintenance contracts, and the act is declared an emergency law to take effect as of July 1, 2016.