Insurance coverage of medical foods for treatment of inherited metabolic disorders

• Authors: Susan A. Berry, University of Minnesota; Mary Kay Kenney, Health Resources and Services Administration; Katharine B. Harris, New York State Department of Health; Rani H Singh, Emory University; Cynthia A. Cameron, Michigan Public Health Institute; Jennifer N. Kraszewski, National Institutes of Health; Jill Levy-Fisch, Save Babies Through Screening Foundation, Inc.; Jill F. Shuger, Health Resources and Services Administration; Carol L. Greene, University of Maryland; Michele A. Lloyd-Puryear, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Coleen A. Boyle, Centers for Disease Control and Prevention
• Journal Title: Genetics in Medicine
• Volume: Volume 15, Number 12
• Publisher: Nature Publishing Group | 2013-12-01, Pages 978-982
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1038/gim.2013.46
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Genetics & Heredity; diet therapy; inborn errors of metabolism; insurance coverage; neonatal screening

Abstract

Purpose:Treatment of inherited metabolic disorders is accomplished by use of specialized diets employing medical foods and medically necessary supplements. Families seeking insurance coverage for these products express concern that coverage is often limited; the extent of this challenge is not well defined. Methods:To learn about limitations in insurance coverage, parents of 305 children with inherited metabolic disorders completed a paper survey providing information about their use of medical foods, modified low-protein foods, prescribed dietary supplements, and medical feeding equipment and supplies for treatment of their child's disorder as well as details about payment sources for these products. Results:Although nearly all children with inherited metabolic disorders had medical coverage of some type, families paid "out of pocket" for all types of products. Uncovered spending was reported for 11% of families purchasing medical foods, 26% purchasing supplements, 33% of those needing medical feeding supplies, and 59% of families requiring modified low-protein foods. Forty-two percent of families using modified low-protein foods and 21% of families using medical foods reported additional treatment-related expenses of $100 or more per month for these products. Conclusion:Costs of medical foods used to treat inherited metabolic disorders are not completely covered by insurance or other resources.