The Affordable Care Act
This law was passed by Congress in 2010 and requires that all states set up health insurance exchanges where small businesses and individuals can choose a health insurance policy that fits their health needs and that they can afford.
These exchanges are meant to be one-stop marketplaces (via websites) where people can shop for health insurance. Open enrollment for the insurance exchanges is open and coverage starts as soon as January 1, 2014.
In order to help you navigate the insurance exchanges, we have created an information sheet detailing the ACA insurance exchanges and the coverage for medical foods for PKU. Click here to download the handout. Please also visit www.healthcare.gov to learn more about how the insurance exchanges will work best for you.
Patient Assistance Programs
Many medical food companies and pharmaceutical companies have patient assistance programs to help individuals who cannot afford who cannot afford drugs or medical foods on their own. Please click here for a list of current programs.
Coverage for Kuvan
The BioMarin Patient and Physician Support (BPPS) is a program that can help you access Kuvan and make insurance and assistance easier. Visit http://www.kuvan.com/patients/parent-caregivers-biomarin-patient-and-physician-support-bpps.html or call 1-877-MY-KUVAN for more information.
Coverage for PKU
The National Organization of Rare Disorders (NORD) has a patient assistance program to help individuals with PKU cover their out of pocket costs associated with their insurance plans, such as: monthly premiums, deductibles, co-payments and co-insurance. This program does not offer assistance with medical foods. Call 1-855-628-0646 or email PKU@rarediseases.org to learn more.
Letter of Medical Necessity
Letter of Medical Exclusion
Insurance Coaches Program
The NPKUA has a new resource to help guide you through the process of obtaining medical foods coverage. The NPKUA Insurance Coaches Program, led by Raenette Franco, Medical Reimbursement and Insurance of Compassion*Works Medical, LLC, is a place that can help. Please click here to request assistance.
Click here for the NPKUA Insurance Coach Volunteer Program Form.