Medical Need Formula Letter.

These auto-post to my Facebook, so to those of you reading it because you saw it posted there: sorry (maybe).  This is a letter Myra's allergist asked me to write to help him fight the nonsense of medical formula costs for these tiny humans who really need it.  It's a messed up system.  Read on if you'd like, but I'm posting this just so I can refer back to it in another post and share with other FPIES families.  This was written on February 5, 2014.  Myra is now on a toddler version of this same formula and it lasts her slightly longer, but the point still stands.

To whom it may concern:

I am writing to make you aware of the costs for the amino acid based formula my daughter, Myra, needs due to her Food Protein Induced Enterocolitis (FPIES).  She is currently on Neocate Infant with DHA/ARA.  Our insurance company is Tricare, specifically TriWest, managed by United Healthcare.  While they do cover the formula when purchased through a medical supply company, Tricare only pays 80% of the costs.  The remaining 20%, our cost, adds up very quickly since one can only lasts Myra 2-3 days. 

There is a substantial discrepancy in cost based on where the formula is purchased. 

$162.29/can from Apria Healthcare (insurance pays 129.83, we pay 32.46)

$94.47/can from Edgepark Medical Supplies (Insurance pays 75.58, we pay 18.89)

If we had the option to purchase the formula with insurance coverage directly from Neocate’s website, or if these medical supply companies followed the same pricing as Neocate’s website, both Tricare and I would save a considerable amount of money.

$38.75/can from Neocate’s website (when purchasing 1 case) (insurance would pay 31.00, we would pay 7.75)

$38.00/can from Neocate’s website (when purchasing 2 cases) (insurance would pay 30.40, we would pay 7.60)

$36.10/can from Neocate’s website (when purchasing 2 cases at their auto-reorder rate) (insurance would pay 28.88, we would pay 7.22)

 

Myra has been going through 12 cans per month, give or take a couple cans.  If we used Apria for her formula, it would cost us $389.52 out of pocket every month after insurance paid $1,557.96.  However, if we were able to purchase the formula directly from Neocate’s website and still receive insurance coverage, it would cost us as "little" as $86.64 per month after insurance paid $346.56.  Clearly, purchasing this formula through a medical supply company is costing families and insurance companies a significant amount of money.  It is worth noting that this amount is for one month and many children with FPIES, Myra included, will need to be on their formula well beyond their first birthday.

Click here to read about Myra's FPIES (journey to her diagnosis, food trial info, recipes, and more).