Requires policies providing prescription drug coverage to cover vitamins and supplements, medical foods, and other medications to mitigate and/or treat the symptoms of mitochondrial disease

6 Co-sponsors

• Tony Avella
• David Carlucci
• Jesse Hamilton
• George Latimer
• Kathleen A. Marchione
• Patty Ritchie

Title of bill

An act to amend the insurance law, in relation to requiring prescription drug coverage to include such supplements and vitamins, medical foods, and other medications as shall be deemed necessary to mitigate and/or treat the symptoms of mitochondrial disease

Purpose

To require insurance policies providing prescription drug coverage to cover vitamins and supplements to mitigate the symptoms of mitochondrial disease.

Summary of provisions

Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 33 which states: (A) Every policy which provides coverage for prescription drugs shall include coverage for the cost of supplements and vitamins as a physician shall deem necessary to mitigate the symptoms of mitochondrial disease diagnosed, through muscle biopsy and/or genetic testing, in a covered person. (B) Such coverage may be subject to annual deductibles and coinsurance as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within the policy.

Section 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 21 which states (A) Every group or blanket policy which provides coverage for prescription drugs shall include coverage for the cost of vitamins and supplements to mitigate the symptoms of mitochondrial disease in a covered person. (B) Such coverage may be subject to annual deductibles and coinsurance as deemed appropriate by the superintendent and as are consistent with those established for other benefits within the policy.

Section 3. Section 4303 of the insurance law is amended by adding a new subsection (oo) which states: 1. Every contract issued by a corporation subject to the provisions of this article which provides coverage for prescription drugs shall include coverage for the cost of vitamins and supplements to mitigate the symptoms of mitochondrial disease in a covered person. 2. Such coverage may be subject to such annual deductibles and coinsurance as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within the contract.

Section 4 is the effective date.

Justification

Mitochondria are tiny parts of almost every cell in the human body and are the 'power house' of the cells. Their job is to synthesize sugar and oxygen into energy which allows the cells to operate normally. Patients with mitochondrial disease (mito-disease) have mitochondria that cannot efficiently turn sugar and oxygen into energy. The disease presents itself differently in each patient. Some patients have had success in mitigating symptoms of the disease through the use of certain vitamins and supplements (referred to as `mito-cockail'). Mitococktails are not currently covered by insurance companies. Depending on what combination is in a patient's mito-cocktail, it can cost anywhere from $300 to $600 per month per patient. Accepted tests for diagnosis are genetic testing and muscle biopsy. The United Mitochondrial Disease Foundation estimates that 1,000 to 4,000 children are born with mitochondrial disease every year. This legislation would provide insurance coverage for vitamins and supplements used to mitigate the symptoms of mito-disease in suffering patients.

Legislative history

New legislation

Fiscal implications

To be determined.

Effective date

This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to policies and contracts issued, reissued, renewed, modified or amended on or after such date.