PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

House Bill 15 was introduced during the 2019 legislative session to mandate treatments for PANDAS in all regulated markets, i.e. large group, small group and individual. The Maryland Insurance Administration was asked to form a workgroup to get information from stakeholders concerning PANDAS and the problems with obtaining coverage of treatment from commercial health benefit plans.

QUESTIONS (June 14, 2019)​ 

1. What are the policies and criteria to determine if IVIG or Rituximab will be covered to treat PANDAS that has not responded to antibiotics?
2. How are the criteria developed?
3. How many requests for authorization are received, and how many are approved?
4. What medical specialty is considered appropriate to make a decision to approve or disapprove a request?
5. How many physicians are in the network to treat PANDAS? How many facilities will provide infusion or other services to treat PANDAS?
6. How many requests for referrals under § 15-830 of the Insurance Article are received? How many are granted?
7. What is the estimated prevalence of PANDAS?

Parent Letter 1

Parent Letter 2

Parent Letter 3

Parent Letter 4

Parent Letter 5

Parent Letter 6

Parent Letter 7​

HHS Update Pandas

Journal Of Child and Adolescent Pharmocology

Neuroimmunol Neuroinflammation

Expert Review Neurother

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• ​House Bill 15 - Health Insurance - Pediatric Autoimmune Neuropsychiatric Disorders - Coverage