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Benson, Mukherji Bill to Help Residents with Eosinophilic Disorders Obtain Protein Formulas under Health Insurance Clears Assembly

(TRENTON) – Legislation sponsored by Assembly Democrats Daniel Benson and Raj Mukherji to require health insurance coverage for certain amino acid-based elemental formulas was approved, 70-0, by the Assembly on Monday.

Amino acid-based formulas are complete nutritional formulas used to treat individuals with eosinophilic disorders. Eosinophilic disorders affect children and adults, and are characterized by above-normal amounts of eosinophils, a type of white blood cell, causing inflammation in one or more areas of digestive system.

Assemblyman Benson invited a constituent from Hamilton who has eosinophilic esophagitis to testify on the bill. Maggie, who is 8 years old, began her medical treatment formula when she was 2 years old and took it through a feeding tube until age 3. Through feeding therapy and the support of her family, Benson testified, she’s been able to drink the formula since then even though the smell and tastes are very hard to withstand.

“Maggie’s mother, Nancy, has struggled with different insurance companies over Maggie’s need for the formula and approvals to get insurance coverage,” said Benson (D-Mercer, Middlesex). “There should not be a constant battle to get something Maggie needs in order to live a happy, healthy life and that her doctor has continually said is medically necessary.”

“There is no cure for eosinophilic disorders, but dietary therapy involving strict avoidance of all foods to which a patient is allergic may alleviate symptoms and prevent further damage to the gastrointestinal tract,” Benson continued. “For those who cannot eat any proteins, amino acid based formula diet provides protein and enables them to maintain proper nutrition in order to live.”

Benson said 10 percent of the New Jersey population has cow’s milk allergies and approximately 3 percent of these children will need formula and approvals to get insurance coverage. He continued to say that included in this 3 percent are eosinophilic diseases, FPIES (digestive allergic disease, malabsorption issues and severe food allergies – not just eosinophilic disorders.

The bill requires certain health insurers (health, hospital, and medical service corporations, commercial individual and group health insurers, health organizations, the State Health Benefits Program, and the School Employees’ Health Benefits Program maintenance) 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.

“This legislation opens the door to a medical treatment that has gone unrecognized by health insurers but embraced by doctors who know it’s the best choice for their patients suffering from eosinophilic disorders,” said Mukherji (D-Hudson). “It is time to expand coverage of these formulas for residents who need it to live better and longer with eosinophilic disorders.”
Pennsylvania, Arizona, Maine, Maryland, Minnesota, Ohio, Oregon and Texas are among the states which have passed similar legislation with little or no fiscal impact.

The bill would take effect the 20th day of enactment and applies to policies or contracts issued or renewed on or after that date.

The legislation was recently approved unanimously by the Assembly Financial Institutions and Insurance Committee. It now goes to the Senate for further consideration.