This text of Louisiana § 22:1059.7 (Required coverage for amino acid-based elemental formulas) is published on Counsel Stack Legal Research, covering Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
NOTE: Section 1059.7 eff. upon appropriation of monies. See Acts 2025, No. 367.
§1059.7. Required coverage for amino acid-based elemental formulas
A. A health insurance issuer offering health coverage plans in this state that
provides benefits for maternity services shall provide coverage for amino acid-based
elemental formulas, regardless of the formula delivery method, to treat a child aged two
years or younger. Coverage applies pursuant to this Section if the child has been diagnosed
by a board-certified allergist or board-certified gastroenterologist and the treating physician
issues a written order stating that the amino acid-based elemental formula is medically
necessary to treat the child for any of the following:
(1)Immunoglobulin E and non-immunoglobulin E mediated allergies to m
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NOTE: Section 1059.7 eff. upon appropriation of monies. See Acts 2025, No. 367.
§1059.7. Required coverage for amino acid-based elemental formulas
A. A health insurance issuer offering health coverage plans in this state that
provides benefits for maternity services shall provide coverage for amino acid-based
elemental formulas, regardless of the formula delivery method, to treat a child aged two
years or younger. Coverage applies pursuant to this Section if the child has been diagnosed
by a board-certified allergist or board-certified gastroenterologist and the treating physician
issues a written order stating that the amino acid-based elemental formula is medically
necessary to treat the child for any of the following:
(1) Immunoglobulin E and non-immunoglobulin E mediated allergies to multiple
food proteins.
(2) Severe food protein-induced enterocolitis syndrome.
(3) Eosinophilic disorders, as evidenced by the results of a biopsy.
(4) Impaired absorption of nutrients caused by disorders affecting the absorptive
surface, functional length, and motility of the gastrointestinal tract.
B. Coverage pursuant to this Section may be subject to annual deductibles,
coinsurance, and copayments consistent with those established under the health coverage
plan.
C.(1) A health coverage plan shall provide coverage pursuant to this Section on a
basis no less favorable than the basis on which prescription drugs and other medications
and related services are covered by the plan, and to the same extent that the plan provides
coverage for drugs that are available only on the orders of a physician.
(2) A utilization review agent acting on behalf of a health coverage plan issuer may
review a treating physician's determination of the medical necessity of the use of an amino
acid-based elemental formula for the treatment of a covered infant or child who is diagnosed
with a disease or disorder listed in Subsection A of this Section.