U.S. Senator Roger Wicker, a Republican from Mississippi, has introduced the Medical Foods and Formulas Access Act. The proposed legislation would require government health programs such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Federal Employee Health Benefit Program to cover specialized formulas, vitamins, individual amino acids, and other medically necessary foods when prescribed by a physician for patients with specific gastrointestinal or inherited metabolic disorders.
Senators Amy Klobuchar (D-Minn.), Sheldon Whitehouse (D-R.I.), Chuck Grassley (R-Iowa), and Representatives John Rutherford (R-Fla.), Debbie Dingell (D-Mich.), and Jim McGovern (D-Mass.) have joined Wicker in introducing the bill.
“It is crucial that Americans with digestive or inherited metabolic disorders have the nourishment they need. When medical food and formula is necessary, time is of the essence. Metabolic disorders are treatable with the right resources. This legislation would ensure medically necessary nutrition is covered by government health programs,” said Senator Wicker.
Senator Klobuchar stated: “Babies and others who rely on specialized foods to keep them out of the hospital should be able to get the food they need to stay healthy. Our common-sense bipartisan legislation cuts through the red tape and ensures those with medical conditions that limit the food they can eat can access the nutrition they need.”
“Patients with cystic fibrosis, Crohn’s disease or other inherited disorders can get very sick without specialized foods. They may suffer problems like stunted growth or even death if their special nutritional needs aren’t met. Our bipartisan legislation would ensure government insurance plans provide coverage for the nutrition they need to thrive. It makes clear that medical nutrition is just as critical for certain patients as prescription drugs or other medical treatment are for others,” said Senator Grassley.
Senator Whitehouse added: “Rhode Islanders shouldn’t have to worry about affording what they need to eat in order to keep medical conditions in check. Our legislation will allow Medicaid and CHIP to start covering the costs of foods and formulas that people need to stay healthy.”
Congressman Rutherford commented: “Our health systems must be structured to support innovative, patient-centered treatments. As co-chair of the Crohn’s and Colitis Caucus, where I advocate for those living with digestive diseases, I am excited to join Rep. McGovern to introduce this important legislation that would make medically necessary nutrition more easily accessible to patients across our nation.”
Congresswoman Dingell noted: “Everyone deserves access to quality, comprehensive health care, including the many patients who require specialized food and formulas to address digestive disease and disorders. Medical foods and formulas are critical to a patient’s health, and should be covered by insurance, just as essential prescription drugs are. Metabolic disorders can be especially dangerous for children, leading to brain damage, stunted growth, and even death. I’m proud to introduce this bill to make sure everyone can get the medically necessary foods and formulas they need.”
Congressman McGovern said: “Access to health care is a human right—no one should have to worry about whether they’ll be able to access the medically necessary food they need to live. I’m disgusted by the stories I hear from many of my constituents who are struggling to get medically necessary food for their child or family member because predatory insurance companies are refusing to cover prescribed foods and formulas just to pad their bottom line. Our bill breaks down barriers to care and ensures that Americans with inherited metabolic diseases or gastrointestinal conditions get the nutrition they need.”
Medically necessary nutrition must be specially formulated rather than naturally occurring food; it is used under ongoing medical supervision either orally or via tube feeding for individuals who cannot otherwise absorb nutrients properly due to their condition.
Coverage requirements currently vary widely across states despite nearly 40 states having some mandate in place regarding these products’ coverage by insurers.
About 2,000 infants each year are diagnosed with an inherited metabolic disorder through newborn screening programs in America; untreated cases can result in toxic reactions from normal foods or nutrient absorption failure in both children and adults.
For pediatric populations especially, risks include inadequate growth as well as cognitive impairment if not managed appropriately using these specialized nutritional products prescribed by healthcare providers.