2022 PANDAS and PANS Coverage

Effective for Massachusetts commercial plans issued or renewed on or after Jan. 1, 2022, Harvard Pilgrim will cover the diagnosis and medically necessary treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS).

This coverage is currently available for members of our commercial plans in New Hampshire and will be extended to members of our Massachusetts commercial plans in keeping with a state mandate (Chapter 260, Acts of 2020) that applies to commercial health insurers in Massachusetts. The Massachusetts PANDAS/PANS coverage applies to both Massachusetts residents and members covered under a Massachusetts plan.

Covered PANDAS/PANS treatment includes, but is not limited to, intravenous immunoglobulin (IVIg) therapy. Harvard Pilgrim’s commercial Intravenous Immune Globulin (IVIG) Medical Policy has been updated to reflect the new coverage.

Publication Information

Annmarie Dadoly,

Joseph O’Riordan,

Kristin Edmonston,
Production Coordinator