SB 1438 Summary

• Requires health benefit plans offered after November 1, 2012 to cover amino-acid based elemental formulas for treating four specified conditions: immunoglobulin E and non-immunoglobulin E mediated allergies to multiple food proteins, severe food protein-induced enterocolitis syndrome, eosinophilic disorders (with biopsy evidence), and impaired nutrient absorption due to gastrointestinal disorders.

• Coverage is mandated only when a treating physician issues a written order stating the formula is medically necessary for a patient diagnosed with one of the listed conditions.

• Health benefit plans must provide formula coverage on a basis no less favorable than coverage for prescription drugs and medications ordered by physicians, including coverage for medically necessary services associated with formula administration.

• Applies to all health benefit plans as defined in Oklahoma Statutes Title 36, Section 6060.4.

• Effective November 1, 2012.