Medical Foods and Formulas Access Act of 2025

Key Points

• This bipartisan bill would require Medicare, Medicaid, CHIP, and federal employee health plans to cover medically necessary foods and formulas for people with severe digestive or inherited metabolic disorders who cannot eat or process regular food.
• Without these specialized formulas, patients face severe consequences including malnutrition, repeated hospitalizations, intellectual disability, and even death. The 2022 formula shortage highlighted how dangerous gaps in access can be.
• Coverage includes specially formulated food products, low-protein modified foods, amino acid preparations, modified fat preparations, nutritional formulas, vitamins, and individual amino acids, but specifically excludes gluten-free foods, diabetes management foods, and weight loss products.
• The bill covers a wide range of conditions including inherited metabolic disorders, malabsorption conditions like short bowel syndrome, food protein allergies, eosinophilic disorders, and inflammatory bowel disease including Crohn's disease and ulcerative colitis.
• Each federal program has a different start date: CHIP and federal employee plans would begin coverage 1 year after enactment, Medicaid within 2 years, and Medicare within 3 years. States with laws providing greater coverage would not be preempted.
• The bill also includes a non-binding sense of Congress encouraging private health insurance plans to offer similar coverage, though it stops short of requiring them to do so.