RS 22:1059.7

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RS 22:1059.7

NOTE: Section 1059.7 eff. upon appropriation of monies. See Acts 2025, No. 367.

§1059.7. Required coverage for amino acid-based elemental formulas

A. A health insurance issuer offering health coverage plans in this state that provides benefits for maternity services shall provide coverage for amino acid-based elemental formulas, regardless of the formula delivery method, to treat a child aged two years or younger. Coverage applies pursuant to this Section if the child has been diagnosed by a board-certified allergist or board-certified gastroenterologist and the treating physician issues a written order stating that the amino acid-based elemental formula is medically necessary to treat the child for any of the following:

(1)Immunoglobulin E and non-immunoglobulin E mediated allergies to multiple food proteins.

(2)Severe food protein-induced enterocolitis syndrome.

(3)Eosinophilic disorders, as evidenced by the results of a biopsy.

(4)Impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract.

B. Coverage pursuant to this Section may be subject to annual deductibles, coinsurance, and copayments consistent with those established under the health coverage plan.

C.(1) A health coverage plan shall provide coverage pursuant to this Section on a basis no less favorable than the basis on which prescription drugs and other medications and related services are covered by the plan, and to the same extent that the plan provides coverage for drugs that are available only on the orders of a physician.

(2)A utilization review agent acting on behalf of a health coverage plan issuer may review a treating physician's determination of the medical necessity of the use of an amino acid-based elemental formula for the treatment of a covered infant or child who is diagnosed with a disease or disorder listed in Subsection A of this Section.

Acts 2025, No. 367, §1, eff. See Act.