Medical Foods and Formulas Access Act of 2025

Expanded Coverage for Essential Nutrition: The bill requires coverage for medically necessary food, including nutritional formulas, vitamins, and amino acids, under Medicare, Medicaid, CH//P, and FEHBP (Section 3(a), (b), (c), and (d)). This provides financial support for treatments essential to preventing malnutrition, surgery, and death (Section 2(1)).

Protection Against Specific Health Risks: By ensuring access to specialized food, the bill helps prevent severe outcomes such as inadequate growth, abnormal development, cognitive impairment, and behavioral disorders, particularly in children (Section 2(2)).

Coverage for Necessary Equipment: The bill ensures that coverage includes the medical equipment and supplies necessary to administer the medically necessary food (Section 3(a)(1)(A), (b)(1), (c)(1), and (d)(1)).

Standardized Definition for Critical Conditions: The bill defines specific covered conditions, such as inherited metabolic disorders, malabsorption issues, and certain food protein allergies, ensuring patients with these specific needs are recognized (Section 3(a)(2)(3)).

Delayed Implementation for Medicare: Coverage under the Medicare program does not take effect until three years after the Act is enacted (Section 3(a)(4)).

Exclusions for Certain Food Types: Medically necessary food does not include foods or vitamins taken for weight loss or disease risk reduction, nor does it include foods marketed for the management of diabetes or as gluten-free for celiac disease (Section 3(a)(2)(2)).

Wait Times for Medicaid and CHIP: While the bill provides new mandates, the coverage for Medicaid does not take effect for two years, and CHIP coverage does not take effect for one year after enactment (Section 3(b)(3) and (c)(3)).