Medical Foods and Formulas Access Act of 2025
Key claim: The Medical Foods and Formulas Access Act of 2025 would require Medicare, Medicaid, CHIP, and FEHBP to cover medically necessary foods and associated equipment prescribed for individuals with digestive or metabolic disorders.
Abstract
(HR5684 · 119th Congress) Medical Foods and Formulas Access Act of 2025 This bill expands coverage under Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Federal Employees Health Benefits Program to include medically necessary food and associated equipment and supplies. The bill defines medically necessary food as specially formulated and processed products (e.g., nutritional formulas) prescribed by health care practitioners for individuals who have special dietary requirements because of certain digestive or metabolic disorders or conditions. Latest action (2025-10-03): Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Why this matters
Medical foods and specialized formulas can cost families thousands of dollars monthly and are inconsistently covered across federal programs and states, creating access gaps for patients with metabolic disorders like PKU or serious digestive conditions requiring enteral nutrition. Mandating coverage across Medicare, Medicaid, CHIP, and FEHBP would establish a uniform federal benefit for a category historically treated as food rather than medicine. As introduced legislation, the bill signals congressional interest but faces the standard path from introduction to enactment.