Medical Foods and Formulas Access Act of 2025

Medicare Coverage for Medically Necessary Food: Section 3(a) adds coverage under Medicare Part B for medically necessary food, low protein modified food products, amino acid preparation products, modified fat preparation products, nutritional formulas, vitamins, and individual amino acids, along with the equipment and supplies needed to administer them. This helps patients with covered conditions get vital nutrition prescribed by their doctor without paying entirely out of pocket.

Medicaid and CHIP Benefits: Sections 3(b) and 3(c) require State Medicaid plans and the State Children's Health Insurance Program to include coverage for medically necessary food and the equipment and supplies needed for administration. This ensures low-income children and families dealing with severe metabolic or digestive disorders have access to life-sustaining nutrition.

Federal Employee Health Plan Protection: Section 3(d) requires health plan contracts under the Federal Employees Health Benefits Program to provide coverage for medically necessary food and necessary administration equipment and supplies. This directly benefits federal workers and their families who require specialized nutritional care.

Support for Private Insurance Expansion: Section 3(e) expresses the sense of Congress that all private health insurance plans should also provide coverage of and access to medically necessary food for individuals with certain digestive and metabolic disorders. This encourages broader health security outside of government-run programs.

Exclusion of Certain Diets and Conditions: Section 3(a)(2) explicitly excludes foods taken as part of an overall diet to reduce disease risk or for weight loss, gluten-free foods marketed for celiac disease or non-celiac gluten sensitivity, and foods marketed for the management of diabetes from the definition of medically necessary food. Individuals seeking coverage for these specific dietary needs will not receive assistance under these federal program expansions.

Delayed Implementation Timelines: Sections 3(a)(4), 3(b)(3), 3(c)(3), and 3(d)(2) stagger the effective dates for these new coverages, ranging from one year to three years after the date of enactment, plus potential delays if state legislation is required for Medicaid and CHIP. Patients who need these specialized foods immediately may face continued out-of-pocket costs and delays before federal programs actually begin providing the required coverage.