This bill adds a new section to chapter 48.43 RCW requiring private health carriers (but not plans for public employees and dependents under chapter 41.05 RCW) to cover initial treatment consisting of three monthly immunomodulatory courses of intravenous immunoglobulin (IVIG) therapy for patients diagnosed with PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) or PANS (pediatric acute-onset neuropsychiatric syndrome) when specified conditions are met. Subsequent IVIG courses must be covered when the treating provider deems them medically necessary. The requirement applies to health plans issued or renewed on or after January 1, 2026. Coverage is conditioned on trials of two or more less intensive treatments that were not effective, not tolerated, or did not result in sustained improvement as measured by a validated instrument, and on a consultation with a pediatric subspecialist (or an adult subspecialist for adolescent or adult patients) plus recommendations from the subspecialist and the primary care provider. The subspecialist consultation may be conducted as a teleconsultation, and health carriers may require clinical reevaluation of the patient at three-month intervals. This is an insurance coverage mandate (a new statutory requirement for health carriers), not a criminal or penalty change. The text supplied does not specify which pediatric or adult subspecialties qualify, what counts as "less intensive treatments," which validated instruments are acceptable, or details about prior authorization, cost-sharing, or enforcement mechanisms. The bill is identified as House Bill 1741 (H-0883.2), 69th Legislature, 2025 Regular Session.

Beginning January 1, 2026, most private health insurers in Washington will be required to pay for an initial three monthly courses of intravenous immunoglobulin (IVIG) for patients diagnosed with PANDAS or PANS when those patients have tried two or more less intensive treatments without sustained benefit and a pediatric or, for adolescents/adults, adult subspecialist has consulted and recommended treatment alongside the primary care provider; further courses must be covered when the treating provider deems them medically necessary and carriers may ask for clinical reevaluation every three months. In practice this likely increases short-term costs for affected insurers and makes IVIG more accessible to patients meeting these conditions, while shifting more administrative and documentation work onto subspecialists, primary care clinicians, and treating providers to confirm prior treatment failures, use a validated symptom measure, provide recommendations, and justify ongoing medical necessity. The requirement does not apply to public employee plans and leaves several implementation details unclear—such as which subspecialties qualify, what counts as “less intensive treatments,” which validated instruments are acceptable, and how prior authorization, patient cost-sharing, or enforcement will work—so insurers and providers will need further guidance before consistent application is possible.