Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Infant Formula Coverage topic
No spam. Unsubscribe anytime.
Committee backs bill to require insurers to cover amino-acid elemental infant formulas
Summary
Senate Insurance Committee voted to report House Bill 467, which would require health insurers to cover amino-acid–based elemental formulas for infants with rare medical conditions; supporters cited high out-of-pocket costs and other states' precedents.
The Senate Insurance Committee on June 4 voted to report House Bill 467 after testimony from a mother whose infant requires an amino-acid–based elemental formula and from health advocates.
The bill would require health insurance coverage for amino-acid–based elemental formulas when prescribed by a physician for infants with medical needs that require an elemental product. Representative Paul Hilferty, who sponsored the measure in the House, said more than 20 states require such coverage and that an elemental formula can cost "$40 to $50 a day," or up to about $15,000 a year for a full year.
Catherine Bivens, the infant's mother, described a months-long diagnostic and treatment journey. "She screamed for an average of 10 hours every day," Bivens said of her daughter before switching to an elemental formula. Bivens told the committee her family has paid out of pocket for the formula, and she urged the legislature to adopt coverage so families without savings are not left without the only medically effective feeding option.
Why it matters: Elemental formulas are medically necessary for a small share of infants with severe allergies or metabolic conditions; supporters said current insurance exclusions and the product’s high cost leave families to shoulder large bills or forgo effective treatment.
Committee action and next steps: The committee reported House Bill 467 favorably by voice vote. Sponsors said they will file a co-author sheet and that the House and Senate will coordinate final language. Witnesses included representatives of patient groups and advocacy organizations; some groups registered in support but did not speak.
Caveats: Witnesses and the sponsor noted variance in plans' formulary rules and in what is eligible for flexible spending accounts; the committee and advocates asked insurers to clarify whether coverage will be widely available and to confirm how coverage will be implemented for specialty products that distribute directly from manufacturers.
