Sen. Jim McGovern seeks coverage for medical foods, formulas

WASHINGTON – Rep. Jim McGovern, D-Mass., has introduced the Medical Foods and Formulas Access Act to require Medicare, Medicaid, the Children’s Health Insurance Program and the Federal Employees 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 bill would ensure state and federal protection for existing coverage. 

“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 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.” 

Joining McGovern in introducing the legislation: Sens. Roger Wicker, R-Miss. Amy Klobuchar, D-Minn., Sheldon Whitehouse, D-R.I., and Chuck Grassley, R-Iowa, and Reps. John Rutherford, R-Fla., and Debbie Dingell, D-Mich. 

Reasons for why the bill is needed include: 

• 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. 

For full text of the legislation, click here.