Date Requested: March 08, 2021
Time Requested: 11:45 AM
Agency: Public Employees Insurance Agency (PEIA)
CBD Number: Version: Bill Number: Resolution Number:
3239 Introduced HB2965
CBD Subject: Insurance


PEIA Basic Insurance

Sources of Revenue:

Special Fund

Legislation creates:

Increases Existing Expenses

Fiscal Note Summary

Effect this measure will have on costs and revenues of state government.

The purpose of this bill is to require Medicaid and insurance coverage of intravenous immunoglobulin therapy (IVIG) for pediatric autoimmune neuropsychiatric disorders associated with streptococcal (PANDAS) infections and pediatric acute onset neuropsychiatric syndrome (PANS) and other autoimmune encephalopathies with prior authorization once all other standard therapies have been exhausted. The incidence and prevalence of PANDAS is not known at this time. Up to Date, a resource of scholarly articles and peer reviewed literature, states the incidence is rare and case studies identified only 10 cases among 30,000 throat cultures. Statistics quoted in the medical literature range from 1 in 200 children to 1 in 2000 children. This disorder is controversial as outlined in the Up to Date review of the disorder. In addition, the American Academy of Pediatrics fails to recognize the relationship between group A strep and PANDAS. IVIG does not have FDA approval for PANDAS. PEIA utilizes United Health Care medical policies which still consider IVIG treatment for PANDAS as experimental and investigational. In an Up to Date review of the disorder the authors quoted the following: “ Immune modulating therapy — Immune modulating therapies include glucocorticoids, plasma exchange, and intravenous immune globulin (IVIG) [77]. If PANDAS is an autoimmune disorder (and this remains controversial), immunomodulatory treatments might be beneficial, but they are as yet unproven and they carry risks. There are few well-designed trials of treatment for PANDAS [78]”.The medical research is still ongoing with PANDAS and the effectiveness of IVIG therapy has not been agreed upon. Autoimmune encephalitis is a clinical syndrome with a wide range of complex neuropsychiatric symptoms. The condition is rare and is estimated by Mayo Clinic to be 14 cases per 100,000 people. The largest experience has been with NMDA receptor encephalitis which has responded well to immune therapy. PEIA currently covers antibiotics for group A streptococci infections, behavior and medical therapy for Obsessive-Compulsive Disorder and Tic Disorders, intravenous or oral steroids, plasmapheresis for PANDAS and autoimmune encephalitis, and IVIG for certain types of autoimmune encephalitis for these diagnoses. The cost to PEIA for coverage of IVIG therapy for PANS/PANDAS is unknown since the dosage, number of treatments and the frequency of treatment has not been standardized. PEIA currently has 51,488 pediatric members. Using PEIA’s in state fee schedule, one dosage for an average ten-year-old child weighing 32kg could range from $2,270.00 to $4,540.00 based on dosage of 1gram/kg, doubled for 2gram/kg. Using the 1 in 200 statistic would mean that 257 of those children would be diagnosed with PANDAS and possibly need treatment with IVIG. 1 in 2000 would be 26 children. Depending on the rate of occurrence, a one-time dosage for 257 children would range from $583,390.00 to $2,332,275.00 depending on dosage used and brand. A one-time dosage for 26 children would be between $59,020.00 and $235,950.00. Current literature and studies range from one-time dosage of IVIG to monthly IVIG infusions. Cost will be increased if medication is used more than once or if the member is having infusions out of state and out of the PEIA fee schedule. For purposes of the fiscal note estimate, an average occurrence rate of 35.375 was used and the mid-point cost at this rate per the above dosages is $160,603.

Fiscal Note Detail

Effect of Proposal Fiscal Year
Fiscal Year
(Upon Full
1. Estmated Total Cost 0 0 160,603
Personal Services 0 0 0
Current Expenses 0 0 160,603
Repairs and Alterations 0 0 0
Assets 0 0 0
Other 0 0 0
2. Estimated Total Revenues 0 0 0

Explanation of above estimates (including long-range effect):

Please explain increases and decreases in personal services, current expenses, repairs and alterations, assets, other costs and revenues, including assumptions and data sources and delineation between start-up and ongoing costs. Please also include a long-range schedule of costs and revenues if fiscal impact is expected to vary in future years.


Please identify any areas of vagueness, technical defects, reasons a bill would not have a fiscal impact, and/or any special issues not captured elsewhere on this form.

    Person submitting Fiscal Note: Jason Haught
    Email Address: