SPRINGFIELD – Governor Rod R. Blagojevich today signed a new law requiring insurance companies to cover the cost of amino acid-based formulas used to treat infants and children with life-threatening allergies. Senate Bill 935 requires amino acid-based formulas to be covered by Illinois-regulated insurance companies whether delivered orally or through invasive surgery.
Most insurance policies already pay for invasive surgery to insert a feeding tube that allows the formula to be delivered directly to the infant’s stomach. Now with this law, insurance policies must provide coverage for diagnosis and whichever means of treatment the prescribing doctor deems to be medically necessary, the least restrictive option, and the most cost effective way to meet the patient’s needs. About 2 percent of children in the U.S. are estimated to be affected by serious allergies that require this treatment, including about 65,000 children in Illinois.
“This is a common-sense approach to help make sure that the best treatment options are available to parents and doctors making decisions about treating life-threatening allergies,” said Gov. Blagojevich. “By avoiding expensive surgical procedures, we are not only providing these children with the formula they need, we are reducing the cost of that treatment for families, providers and insurance companies.”
SB 935 was sponsored by State Senator Terry Link (D-Waukegan) and State Representative Kathleen A. Ryg (D-Vernon Hills). The General Assembly worked closely with Children’s Memorial Hospital to develop this legislation.
“As we look for ways to make sure Illinois families have access to affordable health care, reviewing coverage decisions, like this one for amino acid-based formula, is imperative. When insurance companies’ policies aren’t reasonable, it is our job to fix them,” said Sen. Link.
“It’s baffling to me that insurance companies currently pay up to $20,000 for the procedure that would surgically install the delivery device for this formula into a child’s stomach but will not help families pay for the same formula that their child can drink from a bottle,” said Rep. Ryg.
“We applaud the Governor and the General Assembly for passing this legislation. This law will ensure that medically complex children who need these formulas to survive have access to them, regardless of their families’ income level,” said Jacqueline Pongracic, MD, Division Head of Allergy and Immunology, Children's Memorial Hospital.
This bill requires all Illinois-regulated health or accident insurance policies issued, amended or renewed after this bill takes effect to cover amino acid-based formulas, regardless of delivery method, for the diagnosis and treatment of very serious allergies and ailments. Other states with legislative mandates for amino acid-based formula coverage are: Arizona, Connecticut, Massachusetts, New Hampshire, New Jersey and New York.
SB 935 takes effect immediately.