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State Health Plan Will No Longer Cover Prescription Medical Foods

 

The State Health Plan will no longer cover prescription medical foods as of July 1, 2013.  As of this date, members who take medical foods will be responsible for the full cost at a retail pharmacy.  Express Scripts* home delivery will no longer process orders for medical foods as of July 1, and the prescription will be returned to the member. 

Medical foods are used for the specific dietary management of a disease or condition.  Some medical foods are available as prescription products because they contain an ingredient that is available by prescription, such as a prescription vitamin.  The State Health Plan currently covers a few of these prescription medical foods, including Metanx®, Deplin®, L-methyfolate calcium, Cerefolin®, Folbic® and Foltx®.  Unlike prescription drugs, a product marketed as a medical food does not require approval by the U.S. Food and Drug Administration, and there is no regulation regarding its safety or effectiveness.  

As nonprescription medical foods are currently not covered by the State Health Plan, ALL medical foods will be excluded from coverage as of July 1, 2013, in order to provide consistency.  

If a member is currently prescribed a medical food, he or she will be instructed to ask their provider if an alternative covered product or prescription drug may be used for their treatment.  For more information regarding State Health Plan prescription drug coverage, please contact Express Scripts at 1-888-327-9791. 

 

*Express Scripts manages the member prescription benefit for the State Health Plan.  Medco is now a part of the Express Scripts family of pharmacies.