KRS 304.17A-258: Coverage under health benefit plan for therapeutic food, formulas,

supplements, low -protein modified food products, and amino acid -based

elemental formula.

(1) For purposes of this section:

(a) "Therapeutic food, formulas, and supplements" means products intended for

the dietary treatment of inborn errors of metabolism or genetic conditions,

including but not limited to eosinophilic disorders, food protein allergies, food

protein-induced enterocolitis syndrome, mitochondrial disease, and short

bowel disorders, under the direction of a physician, and includes amino acid -

based elemental formula and the use of vitamin and nutritional supplements

such as coenzyme Q10, vitamin E, vitamin C, vitamin B1, vitamin B2,

vitamin K1, and L-carnitine;

(b) "Low-protein modified food" means a product formulated to have less than

one (1) gram of protein per serving and intended for the dietary treatment of

inborn errors of metabolism or genetic conditions under the direction of a

physician; and

(c) "Amino acid -based elemental formula" means a product intended for the

diagnosis and dietary treatment of eosinophilic disorders, food protein

allergies, food protein-induced enterocolitis, and short -bowel syndrome under

the direction of a physician.

(2) A health benefit p lan that provides prescription drug coverage shall include in that

coverage therapeutic food, formulas, supplements, and low -protein modified food

products for the treatment of inborn errors of metabolism or genetic conditions,

including those that are com pounded, if the therapeutic food, formulas,

supplements, and low -protein modified food products are obtained for the

therapeutic treatment of inborn errors of metabolism or genetic conditions,

including but not limited to mitochondrial disease, under the d irection of a

physician. Coverage under this subsection may be subject, for each plan year, to a

cap of twenty -five thousand dollars ($25,000) for therapeutic food, formulas, and

supplements and a separate cap for each plan year of four thousand dollars ($ 4,000)

on low -protein modified foods. Each cap shall be subject to annual inflation

adjustments based on the consumer price index. Coverage under this section shall

not be denied because two (2) or more supplements are compounded.

(3) The requirements of t his section shall apply to all health benefit plans issued or

renewed on and after January 1, 2017.

(4) Nothing in this section or KRS 205.560, 213.141, or 214.155 shall be construed to

require a health benefit plan to provide coverage for therapeutic food s, formulas,

supplements, or low -protein modified food for the treatment of lactose intolerance,

protein intolerance, food allergy, food sensitivity, or any other condition or disease

that is not an inborn error of metabolism or genetic condition.