What's happening
This bill requires health insurance policies in New York to cover at least $3,000 annually for medically necessary infant and baby formulas.
Why it matters
Reduces financial burden on families. By mandating insurers to cover at least $3,000 per year for medically necessary infant and baby formulas, the bill helps families whose children require specialized nutrition due to health conditions, potentially preventing high out-of-pocket expenses.
Supports children with serious medical needs. The coverage applies to infants and babies with conditions like inherited metabolic disorders, severe allergies, Crohn’s Disease, and gastrointestinal issues, ensuring access to critical, often life-saving nutrition.
Establishes clear medical necessity criteria. Physicians or authorized health care providers must certify the formula as "clearly medically necessary" and effective as disease-specific treatment, preventing misuse and ensuring targeted benefit for those in genuine need.
Creates insurance parity with other covered treatments. By putting infant and baby formulas on par with other medically necessary treatments and nutritional therapies, the bill addresses gaps where such formulas may not have been covered previously, potentially improving health outcomes and reducing hospitalizations.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Cover Infant Formula Costs
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Cover Baby Formula Costs
In Assembly Committee · Insurance · Sponsor Kimberly Jean-Pierre
Full text
4 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2305
2019-2020 Regular Sessions
IN SENATE
January 24, 2019
Introduced by Sen. BAILEY -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring certain health insurance policies to include coverage for the cost of certain infant and baby formulas
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 21 of subsection (i) of section 3216 of the insurance law, as amended by chapter 469 of the laws of 2018, is amended to read as follows:
(21) Every policy which provides coverage for prescription drugs shall include coverage for the cost of enteral, infant and baby formulas for home use, whether administered orally or via tube feeding, for which a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law has issued a written order. Such written order shall state that the enteral, infant and baby formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen. Specific diseases and disorders for which enteral, infant and baby formulas have been proven effective shall include, but are not limited to, inherited diseases of amino acid or organic acid metabolism; Crohn's Disease; gastroesophageal reflux; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies including, but not limited to immunoglobulin E and nonimmunoglobulin E-mediated allergies to multiple food proteins; severe food protein induced enterocolitis syndrome; eosinophilic disorders; and impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract. Enteral, infant and baby formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively. Coverage for
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05414-02-9
S. 2305 2
certain inherited diseases of amino acid and organic acid metabolism as well as severe protein allergic conditions shall include modified solid food products that are low protein or which contain modified protein, or are amino acid based which are medically necessary, and such coverage for such modified solid food products for any calendar year or for any continuous period of twelve months for any insured individual shall not exceed two thousand five hundred dollars. Coverage for infant and baby formulas for any calendar year or any continuous period of twelve months for any insured individual shall be no less than three thousand dollars.
§ 2. Paragraph 11 of subsection (k) of section 3221 of the insurance law, as amended by chapter 469 of the laws of 2018, is amended to read as follows:
(11) Every policy which provides coverage for prescription drugs shall include coverage for the cost of enteral, infant and baby formulas for home use, whether administered orally or via tube feeding, for which a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law has issued a written order. Such written order shall state that the enteral, infant and baby formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen. Specific diseases and disorders for which enteral, infant and baby formulas have been proven effective shall include, but are not limited to, inherited diseases of amino-acid or organic acid metabolism; Crohn's Disease; gastroesophageal reflux; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies including, but not limited to immunoglobulin E and nonimmunoglobulin E-mediated allergies to multiple food proteins; severe food protein induced enterocolitis syndrome; eosinophilic disorders and impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract. Enteral, infant and baby formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively. Coverage for certain inherited diseases of amino acid and organic acid metabolism as well as severe protein allergic conditions shall include modified solid food products that are low protein or which contain modified protein, or are amino acid based which are medically necessary, and such coverage for such modified solid food products for any calendar year or for any continuous period of twelve months for any insured individual shall not exceed two thousand five hundred dollars. Coverage for infant and baby formulas for any calendar year or any continuous period of twelve months for any insured individual shall be no less than three thousand dollars.
§ 3. Subsection (y) of section 4303 of the insurance law, as amended by chapter 469 of the laws of 2018, is amended to read as follows:
(y) Every contract which provides coverage for prescription drugs shall include coverage for the cost of enteral, infant and baby formulas for home use, whether administered orally or via tube feeding, for which a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law has issued a written order. Such written order shall state that the enteral, infant and baby formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen. Specific diseases and disorders for which enteral, infant and baby formulas have been proven effective shall include, but are not limited to, inherited diseases of amino-acid or organic acid metabolism; Crohn's Disease; gastroesophageal reflux; disorders of gastrointestinal motility such as chronic intestinal pseu-
S. 2305 3
do-obstruction; and multiple, severe food allergies including, but not limited to immunoglobulin E and nonimmunoglobulin E-mediated allergies to multiple food proteins; severe food protein induced enterocolitis syndrome; eosinophilic disorders; and impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract. Enteral, infant and baby formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively. Coverage for certain inherited diseases of amino acid and organic acid metabolism as well as severe protein allergic conditions shall include modified solid food products that are low protein, or which contain modified protein, or are amino acid based which are medically necessary, and such coverage for such modified solid food products for any calendar year or for any continuous period of twelve months for any insured individual shall not exceed two thousand five hundred dollars. Coverage for infant and baby formulas for any calendar year or any continuous period of twelve months for any insured individual shall be no less than three thousand dollars.
§ 4. The opening paragraph of paragraph 25 of subsection (b) of section 4322 of the insurance law, as amended by chapter 388 of the laws of 2013, is amended to read as follows:
Prescription drugs, obtained at a participating pharmacy under a prescription written by an in-plan or out-of-plan provider, including contraceptive drugs or devices approved by the federal food and drug administration or generic equivalents approved as substitutes by such food and drug administration [and], nutritional supplements (formulas), whether administered orally or via a feeding tube for the therapeutic treatment of phenylketonuria, branched-chain ketonuria, galactosemia and homocystinuria[, obtained at a participating pharmacy under a prescription written by an in-plan or out-of-plan provider] and infant and baby formulas for home use for which a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law has issued a written order. Such written order shall state that the infant or baby formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen for those individuals who are or will become malnourished or suffer from disorders, which if left untreated, cause chronic physical disability, mental retardation or death. Specific diseases for which infant and baby formulas have been proven effective shall include, but are not limited to, inherited diseases of amino acid or organic acid metabolism; Crohn's Disease; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies which if left untreated will cause malnourishment, chronic physical disability, mental retardation or death. Infant and baby formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively. Coverage for infant and baby formulas for any calendar year or any continuous period of twelve months for any insured individual shall be no less than three thousand dollars. Health maintenance organizations, in addition to providing coverage for prescription drugs at a participating pharmacy, may utilize a mail order prescription drug program. Health maintenance organizations may provide prescription drugs pursuant to a drug formulary; however, health maintenance organizations must implement an appeals process so that the use of non-formulary prescription drugs may be requested by a physician or other provider.
S. 2305 4
§ 5. 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 all policies and contracts issued, renewed, modified, altered, or amended on or after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to requiring certain health insurance policies to include coverage for the cost of certain infant and baby formulas
Purpose
To allow parents to affordably provide medically necessary formulas for infants who would become malnourished or suffer from disorders if these particular formulas were made unavailable to them. These disorders,. if left untreated, may cause chronic physical disability, mental retarda- tion or death.
Summary of specific provisions
This bill would require that coverage by any policy which provides coveragò for prescription drugs must provide coverage for the cost of infant and baby formulas which are proven effective as a disease-specif- ic regimen. Such formulas must be prescribed by a physician or other license health care professional. Coverage for certain infant and baby formulas for any twelve months shall not be less than $3000.
Justification
Many infants have been prescribed medically necessary formulas which have been proven effective as a disease-specific treatment regimen for infants who are, or will become, malnourished or suffer from disorders, which, if left untreated, may cause chronic physical disability, mental retardation or death. Specific diseases for which infant formulas have been proven effective include: inherited diseases of amino acid; Crohn's disease; gastroesophageal reflux with failure to thrive; and multiple, severe food allergies. Symptoms of such allergies may also include: loose stools, which may contain blood; vomiting; hives; diarrhea; abdo- minal cramps; coughing or wheezing; runny nose; watery eyes; itchy skin rash, often around the mouth; and colic.
Infant and baby formulas, which must be purchased to prevent symptoms from occurring, are often more expensive than regular formulas. Espe- cially during these difficult economic times, parents need help to provide the food that is best and safest for their infants. Currently, in New York State, insurance companies are not required to cover these medically necessary formulas. However, other states, such as Arizona, Colorado, Louisiana, and Massachusetts do have provisions which require insurance companies to cover such infant formulas.
Legislative history
2017-18: Referred to Insurance
Effective date
First of January next succeeding the date it becomes a law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.