Press Releases

WASHINGTON—Congressman Jim McGovern (D-MA) 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 McGovern in introducing this legislation are Senators Roger Wicker (R-MS), Amy Klobuchar (D-MN), Sheldon Whitehouse (D-RI), and Chuck Grassley (R-IA), and Representatives John Rutherford (R-FL) and Debbie Dingell (D-MI).

“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.  

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