Insurance coverage sought for amino-acid formula

The Banking, Commerce and Insurance Committee heard testimony Feb. 26 on a bill that would require insurance coverage for some amino-acid formula treatments.

Under LB218, introduced by Lincoln Sen. Bill Avery, any individual or group insurance policy or self-funded employee benefit plan would be required to include coverage for amino-acid based formulas for short bowel syndrome or eosinophilic disorders.

Coverage would require a written order from a physician indicating that the amino-acid formula was medically necessary and would be the primary source of nutrition. Insurance coverage would be retroactive to Jan. 1, 2012, and cover children until age five.

“We did this with the expectation that by that age families would have worked out … a safe and reliable nutrition plan that would make coverage no longer necessary,” Avery said.

Kari Wade of the Nebraska Nurses Association testified in support of the bill, saying children are born in Nebraska every month who are unable to process proteins and require expensive amino-acid formulas for the nutrition necessary to sustain them.

Middle- and working-class families are the hardest hit, Wade said, because they cannot afford to pay the out-of-pocket cost for the amino-acid formula and don’t qualify for Medicaid, which covers it.

“Private insurance companies in Nebraska, however, do not provide coverage,” she said.

Kristin Geist, a pediatric nurse and mother of a child who cannot digest milk or soy protein, also supported the bill. Amino-acid formula is the only treatment for her daughter’s condition, Geist said, and costs between $260 and $375 a month.

Michaela Valentin of Blue Cross and Blue Shield of Nebraska opposed the bill. Also testifying on behalf of Coventry and United Healthcare, Valentin said the implications of the federal Affordable Care Act on any state mandated coverage are complex and unresolved.

In addition, she said, all three carriers cover items such as pumps and other tools related to delivering formula, but do not cover the formula itself.

“Historically, the carriers have not covered any type of formula at any price point,” Valentin said.