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Greenstein/Cruz-Perez Bill Requiring Health Insurance Coverage for Certain Amino Acid Based Elemental Formula Clears Senate

Greenstein Workers

RENTON – Today, legislation sponsored by Senators Linda Greenstein and Nilsa Cruz-Perez requiring insurance coverage of amino acid-based elemental formulas for treating eosinophilic disorder was approved today by the full Senate.

“Eosinophilic disorder is a life-altering disorder which can be treated with appropriate intervention and will dramatically improve these people’s lives,” said Senator Greenstein (D-Mercer/Middlesex). “Amino-acid based formulas, which are essential to so many with this condition, need to be covered and this legislation will ensure that.”

The bill, S-2649, would require insurance coverage of amino acid-based elemental formulas for treating eosinophilic disorders. Under the bill, health insurers (health, hospital, and medical service corporations, commercial individual and group health insurers, health maintenance organizations, the State Health Benefits Program, and the School Employees’ Health Benefits Program) would be required to provide health benefits coverage for expenses incurred for the purchase and administration of amino acid-based elemental formulas, regardless of delivery method, for treating eosinophilic disorders that have been determined by a covered patient’s physician to be medically necessary.

“The ultimate goal is for patients to receive the much needed nutrition without having to fight insurers to cover the costs of this necessary prescription medical formula,” said Senator Cruz-Perez (D-Camden/Gloucester). “This legislation will make it less stressful for patients to get their food and the treatment they need without putting more pressure on their lives than they already have.”

Amino acid–based elemental formulas are complete nutrition formulas designed for individuals who have a dysfunctional or shortened gastrointestinal tract and are unable to tolerate and absorb whole foods or formulas composed of whole proteins, fats, and/or carbohydrates.

Eosinophilic disorders and short bowel syndrome (SBS) compromise a person’s ability to ingest food orally.

The bill was approved by the Senate with a vote of 32-0. The bill was passed by the Assembly in 2016 with a vote of 70-0-0. Now the bill goes to the Governor’s desk for further consideration.