Reimbursement for Medical Foods
Guardion Health Sciences
Medical foods, which are used for the dietary management of a medical disorder or disease, have been shown to meet needs unmet by other medical products. Neither a prescription drug nor a supplement, medical foods are a category of their own. These safe and effective products give people the nutrients they need to stave off or prevent the progression of serious diseases.
Medical foods are made from natural molecules found in foods. A single dosage or serving of a medical food can provide the nutritional value equivalent of what you would get eating several pounds of fruits, vegetables or fish. With purified, natural ingredients that meet the highest standards of safety at the FDA, medical foods have very few side effects.
The global market for medical foods continues to grow at a rapid pace. However, gaps in insurance reimbursement for medical foods could limit patient access to these safe and effective products.
Are Medical Foods Covered By Insurance?
Consider Lumega-Z, a medical food formulated with antioxidant and anti-inflammatory ingredients called carotenoids, to protect the health of your eyes’ cells and preserve your visual performance. Studies suggest that taking Lumega-Z regularly can build up the macular pigment, a protective pigment layer covering the macula, or central portion of the retina, which is responsible for detailed vision.
Restoring and replenishing the macular pigment can delay or prevent the risk of losing vision to age-related macular degeneration. Moreover, research indicates it could reduce the risk of neurodegenerative diseases like Alzheimer’s and other forms of dementia, which have been linked to a depleted macular pigment.
The problem is, there are no national insurance policy guidelines that require insurers to cover medical foods like Lumega-Z. In spite of the demonstrated benefits of Lumega-Z and medical foods that manage other serious conditions (e.g., inherited metabolic disorders and digestive disorders), coverage is highly variable by state and by health plan. Each state can decide how they want to cover medical foods. They can put limits on the foods they cover, the conditions they address and eligibility requirements.
Now, Lumega-Z in particular is a very cost-effective product. It packs a wide range of nutritional ingredients into one product that is highly absorbable — so your body gets as many nutrients as it can from a serving. Lumega-Z can actually replace a daily multivitamin and other supplements. But for people on limited or fixed incomes that rely on insurance coverage for the medicines they need, every dollar matters.
Although national bills have been proposed to require coverage of medical foods for certain conditions, no bill has yet to pass. Organizations like Advocates for Medical Foods are dedicated to spreading awareness of the importance of medical foods in managing chronic diseases and demanding better access to these products.
What to Do If Your Medical Food Isn’t Covered by Your Insurance
Insurance coverage and reimbursement for medical foods depend on what state you are in and what kind of health plan you have. If your health plan does not cover medical foods in the formulary, you can request a formulary exception. The exception process differs by provider, so you will need to find the requirements for your plan. You may need your healthcare provider to write a letter of medical necessity. Asking for a formulary exception does not guarantee your health plan will grant it and cover your medical food.
Tax Savings and Use of Health Savings Accounts
Even though medical foods are not covered by insurance in most states, using Lumega-Z can provide a few financial benefits. The cost of Lumega-Z can be used as a tax deduction for medical treatment. And, most Health Savings Accounts (HSAs) allow the use of these funds for purchase of this type of medical treatment.
Learn More about Lumega-Z
For more information about Lumega-Z, please contact Guardion Health Sciences today.