Mass. Lawmakers Override Veto On Long-Term Antibiotics For Lyme

At three minutes to midnight on Sunday night, the Massachusetts Senate voted 37-1 to override Gov. Charlie Baker's veto of a bill requiring health insurers to cover long-term antibiotic treatment for Lyme disease.

Coming on the heels of a similarly overwhelming vote in the House the day before, the vote meant that, effective immediately, commercial insurers must cover the extended antibiotics when prescribed by a licensed physician, Rep. David Linsky said.

"Virtually everyone in the Legislature has been affected by Lyme disease in some way," said Linsky, a Natick Democrat whose son had long-term symptoms and who helped champion the bill. "Either they've had Lyme disease, a family member had Lyme disease or a close friend or neighbor had Lyme disease. The public is very much aware of this, and this is an example of the Legislature responding to requests from members of the public."

Massachusetts has one of the highest rates of Lyme disease in the country; thousands and probably tens of thousands of people here catch it from deer ticks every year. Most are cured with a short course of antibiotics, but some suffer from lingering symptoms — fatigue, joint pain, brain fog. How they should be treated — and whether they have an ongoing infection or just after-effects — is one of the most contentious issues in American medicine.

Massachusetts health insurers and several Massachusetts medical organizations came out against the Lyme disease bill. They warned that long-term antibiotics are dangerous to patients, have not been proven to be effective and could also contribute to the looming problem of drug-resistant "superbugs."

"Even though insurers are now required to pay for long-term antibiotic treatments for Lyme disease, patients should not really be asking for them," said Dr. Ben Kruskal, chief of infectious disease at Atrius Health. "Treatments like this have been shown to have significant risks, and, in several trials, to be unhelpful with the long-term symptoms the patients complain about."

Gov. Baker vetoed the bill last week, saying he cared about Lyme disease patients but citing medical "uncertainty" about whether the long-term antibiotics were safe or effective against Lyme. From his veto letter:

"Further, requiring coverage of experimental drugs for off-label use sets a concerning precedent. We should only be mandating coverage for evidence-based therapies that have proven to be clinically effective, whether we are considering the treatment of Lyme disease or any other medical disease or condition."

A state analysis suggests the bill will add only about 13 cents on average to annual health insurance premiums.

Rhode Island and Connecticut had already passed similar laws.

Asked about possible next steps, Linsky said they must come not from the Legislature but from the medical and scientific community: To figure out better diagnostic tests and better treatment protocols for Lyme disease.