Insurance coverage of medical foods for treatment of inherited metabolic disorders

Susan A Berry, Mary Kay Kenney, Katharine B. Harris, Rani H. Singh, Cynthia A. Cameron, Jennifer N. Kraszewski, Jill Levy-Fisch, Jill F. Shuger, Carol L. Greene, Michele A. Lloyd-Puryear, Coleen A. Boyle

Research output: Contribution to journalArticle

10 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)978-982
Number of pages5
JournalGenetics in Medicine
Volume15
Issue number12
DOIs
StatePublished - Dec 1 2013

Keywords

  • diet therapy
  • inborn errors of metabolism
  • insurance coverage
  • neonatal screening

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    Berry, S. A., Kenney, M. K., Harris, K. B., Singh, R. H., Cameron, C. A., Kraszewski, J. N., Levy-Fisch, J., Shuger, J. F., Greene, C. L., Lloyd-Puryear, M. A., & Boyle, C. A. (2013). Insurance coverage of medical foods for treatment of inherited metabolic disorders. Genetics in Medicine, 15(12), 978-982. https://doi.org/10.1038/gim.2013.46