WASHINGTON – U.S. Senator Roger Wicker, R-Miss., introduced the Medical Foods and Formulas Access Act. This legislation would require Medicare, Medicaid, the Children’s Health Insurance Program, and the Federal Employee Health Benefit Program to cover specialized formulas, vitamins, individual amino acids, and other medically necessary foods prescribed by a physician for patients with specific gastrointestinal and inherited metabolic disorders.  The legislation ensures state and federal protection for existing coverage.

Joining Senator Wicker in introducing this legislation are Senators Amy Klobuchar, D-Minn., Sheldon Whitehouse, D-R.I., and Chuck Grassley, R-Iowa., and Representatives John Rutherford, R-Florida., Debbie Dingell, D-Mich., and Jim McGovern, D-Mass.

“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.

“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,” said Senator Klobuchar. “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.

“Rhode Islanders shouldn't have to worry about affording what they need to eat in order to keep medical conditions in check,” said Senator Whitehouse.  “Our legislation will allow Medicaid and CHIP to start covering the costs of foods and formulas that people need to stay healthy.”

“Our health systems must be structured to support innovative, patient-centered treatments,” said Congressman Rutherford. “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.”

“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,” said Congresswoman Dingell.

“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,” said Congressman McGovern. “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.”

For full text of the legislation, click here.

Background:

• Medically necessary nutrition must be specially formulated and processed as opposed to naturally occurring food for the partial or exclusive feeding of an individual by means of oral intake or enteral feeding by tube.  Additionally, this food must only be used for an individual receiving active and ongoing medical supervision.
• Nearly 40 states require coverage of medically necessary nutrition, but coverage is highly variable from state to state. 
• Approximately 2,000 infants every year are diagnosed with an inherited metabolic disorder through the newborn screening program.  When these conditions are left untreated in both children and adults, food can become toxic, or the body can fail to absorb necessary nutrients. 
• Risks in pediatric populations are particularly profound and include inadequate growth, abnormal development, cognitive impairment, and behavioral disorders.  These individuals must turn to medically necessary nutrition, such as highly specialized formulas, both as a treatment for their condition and as sustenance.  These conditions cannot be solely managed by avoiding certain foods.  Specialized medically necessary nutrition prescribed by a health care provider is standard-of-care treatment for these patients and is essential to healthy development.