Medical Foods Legislation
What is a medical food?
Medical foods are specially formulated and processed (as opposed to a naturally occurring foodstuff used in its natural state) for the partial or exclusive feeding of a patient by means of oral intake or enteral feeding by tube.
Medical Foods are intended for the dietary management of a patient who, because of therapeutic or chronic medical needs, has limited or impaired capacity to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain nutrients, or who has other special medically determined nutrient requirements, the dietary management of which cannot be achieved by the modification of the normal diet alone.
Medical foods provide nutritional support specifically modified for the management of the unique nutrient needs that result from the specific disease or condition, as determined by medical evaluation.
Medical foods should ONLY be used under medical supervision for a patients receiving active and ongoing medical care wherein the patient requires medical care on a recurring basis for, among other things, instructions on the use of the medical food.
In Eosinophilic Gastrointestinal Disorders, medical foods are used for diagnostic and therapeutic purposes. These medical treatment modalities should be covered by insurance companies, just like any other prescribed pharmaceutical. Elemental formula is as critical to the treatment plan of some patients with EGID, as insulin is to a diabetic.
Formula Legislation in Georgia: The Georgia Medical Foods Coalition
By Christine Cox
The newly formed Georgia Medical Foods Coalition has brought together patients suffering from food tolerance and absorption disorders, such as EGIDs, with the metabolic disorders community in support of insurance reimbursement legislation. Both groups of patients use highly specialized and very expensive formulas, collectively known as "medical foods," in the management of their respective disorders. Since medical foods are not considered to be prescription drugs by the Food and Drug Administration, insurance companies generally refuse to extend coverage to them even though they play a vital role in treating disorders from PKU to Eosinophilic Esophagitis. Families therefore are left struggling to pay for both healthcare-related expenses and the exorbitant cost of these essential medical foods.
The Georgia Medical Foods Coalition has obtained bipartisan sponsorship for legislation that would require insurance companies to pay for elemental formulas used in the diagnosis and treatment of EGIDs, multiple food protein allergies, food protein-induced enterocolitis syndrome and short bowel syndrome as well as medical foods used in the management of inherited metabolic and genetic disorders. This legislation is supported by numerous organizations, including APFED, the March of Dimes, NASPGHAN, Emory Children's Center, Children's Center for Digestive Health Care and Georgia PKU Connect.
By joining forces, the metabolic and GI/allergy communities have been able to share resources and draw attention to the importance of medical foods in the treatment of these rare disorders. Insurance coverage for medical foods used in the treatment of metabolic disorders is mandated in 33 states, and thirteen states currently require insurance coverage for elemental formulas used to diagnose and treat food tolerance and absorption disorders. Although some states cover both issues in the same section of the law, this is the first instance in which the metabolic and GI/allergy communities have introduced a unified bill.
Please assist with gaining cosponsors for the Medical Foods Equity Act of 2011, sponsored by Senator F. Kerry. Let YOUR senator know how important the bill is to you.
The Georgia Medical Foods Equity Act should be introduced into the Georgia legislature in the upcoming session. If you are a Georgia resident and have had difficulty obtaining insurance coverage for your elemental formula or medical food, please e-mail your story to georgiamedicalfoods@gmail.com. For further updates on the progress of the bill, please join the Georgia Medical Foods Coalition
For information on the Federal Medical Foods Equity Act of 2011 click here
