State RegulationsPA specificDifficulty 2/5
The parents of a Pennsylvania child with an inherited metabolic disorder learn that their health policy excludes the specialized formulas the child's physician has prescribed as the primary treatment. Which Pennsylvania mandate requires coverage of these products?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Pennsylvania's medical foods mandate, 40 P.S. §§ 3901-3909, requires health coverage for the specialized therapeutic products prescribed as treatment for conditions such as inherited metabolic disorders. The formulas function as medicine for these children, and the Pennsylvania mandate prevents a policy from sidestepping them as mere groceries. Cancer therapy is addressed separately at 40 P.S. § 764b and childhood immunizations at 40 P.S. § 3503.
Why the other options are wrong
- A) 40 P.S. § 764b is the cancer therapy mandate, not the medical foods provision.
- B) 40 P.S. § 3503 mandates childhood immunizations, not therapeutic formulas.
- C) 40 P.S. § 775.1 covers adopted children, unrelated to metabolic disorder treatment.
Memory hook
Formula as medicine: 3901-3909 covers medical foods.