Committee advances substitute to require coverage for IVIG in certain pediatric neuropsychiatric disorders with prior authorization

A committee substitute for Senate Bill 297 that would require coverage for intravenous immunoglobulin (IVIG) therapy for specified pediatric neuropsychiatric disorders was reported to the full Senate with the recommendation that it pass and a first referral to the Finance Committee.

The committee’s counsel told members the bill "requires coverage for intravenous immunoglobulin therapy for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric onset neuropsychiatric syndrome and autoimmune encephalopathy encephalopathies." Counsel said the bill conditions coverage on physician prior authorization showing that other treatments have been exhausted. Counsel also said the substitute resolves a code conflict by changing a code section and moves the PEIA effective date from January to July; counsel indicated a fiscal note had been requested and that the affected agencies would include PEIA and BMS. Counsel said the bill’s general effective date is 90 days, while noting an internal effective date tied to PEIA’s plan year.

Senators discussed the clinical profile and the need for expert testimony. A sponsoring senator who has carried the measure in past sessions described PANDAS/PANS as disorders that can follow streptococcal infections and said research and patient advocates had highlighted cases where prior coverage was denied; the senator said the diseases are rare but can severely affect patients and families and that the bill aims to ensure coverage after prior authorization. Other members asked for medical experts; a senator noted experts have testified at prior meetings and pledged to bring speakers to a future meeting if needed.

The committee voted by voice to agree to the committee substitute and to report it to the full Senate with recommendation that it pass; the chair declared "the ayes have it." The counsel recorded the bill’s second reference to the Finance Committee and that a fiscal note had been requested.