Medical Foods and Formulas Access Act of 2025
Sponsored By: Senator Roger Wicker
Introduced
Summary
This bill would require federal health programs to cover medically necessary foods, vitamins, and individual amino acids for digestive and inherited metabolic disorders. It defines who qualifies, what counts as medically necessary food, and phases the coverage into Medicare, Medicaid, CHIP, and the Federal Employees Health Benefits Program to create a consistent approach across programs.
Show full summary
- Families and children would see guaranteed coverage in CHIP and Medicaid for prescribed specialty formulas and nutrition products. About 2,000 babies a year are noted as being diagnosed with disorders that may need these products.
- Medicare beneficiaries would gain a new benefit for medically necessary foods and related equipment, with payment set at 80% of the lesser of the charge or a Secretary-set fee and a three-year implementation timeline.
- Medicaid enrollees and state programs would be required to cover medically necessary food and administering equipment, and benchmark or benchmark-equivalent plans could not exclude that benefit; states generally get two years to comply.
- Federal employees would be covered because the Federal Employees Health Benefits Program contracts would be required to include medically necessary foods and related supplies, typically within one contract year.
- The bill expresses that private health plans should provide similar coverage so patients and physicians can choose full treatment options, while allowing states to keep or adopt stronger protections.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
6 provisions identified: 5 benefits, 0 costs, 1 mixed.
CHIP must cover medical foods
If enacted, CHIP would be required to cover medically necessary foods and the supplies to administer them for eligible children. Coverage would apply to items furnished one year after enactment. States that need new State laws would get extra time to comply.
Medicaid must cover medical foods
If enacted, Medicaid would be required to cover medically necessary foods and the equipment to give them. States could not enroll people in benchmark plans that leave out these foods. The rule would start two years after enactment. States that need new State laws would get extra time to comply.
Medicare coverage and payment rules
If enacted, Medicare would cover medically necessary foods and needed equipment for qualifying beneficiaries. Medicare would pay 80% of the lesser of the provider's charge or an HHS fee schedule amount, creating a 20% coinsurance exposure. Coverage would apply to items furnished three years after enactment. The bill would define which foods qualify.
Combined medical food prescriptions covered
If enacted, the bill would clarify that coverage is not limited when medically necessary foods or supplies are prescribed together. This clarification would apply across Medicare, Medicaid, CHIP, and FEHBP.
Federal employee plans must cover medical foods
If enacted, Federal Employee Health Benefits Program plans would have to cover medically necessary foods and the supplies to administer them. The requirement would apply to contract years starting one year after enactment.
States may require stronger coverage
If enacted, the bill would not stop States from requiring broader coverage than the federal minimum. States could keep rules that are stronger than these new standards.
Sponsors & CoSponsors
Sponsor
Roger Wicker
MS • R
Cosponsors
Amy Klobuchar
MN • D
Sponsored 12/2/2025
Chuck Grassley
IA • R
Sponsored 12/2/2025
Sheldon Whitehouse
RI • D
Sponsored 12/2/2025
Jon Ossoff
GA • D
Sponsored 3/17/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in