The Trinh family was happy to see the government act so quickly to its plea for better health benefit coverage for medically required, specialized infant formula.
Beginning May 1, parents of children unable to tolerate common infant formula, either because of a complex food allergy or a specific medical condition, can apply for government-sponsored benefits through Alberta Blue Cross.
“These formulas are costly, medically necessary and, in many cases, cause families considerable financial hardship,” said associate minister of health Brandy Payne on Monday. “After speaking with these parents and hearing about the financial strain they are under, our government decided this coverage should be provided. It’s the right thing to do.”
The Trinhs, Natalie and Richy, were one of these families. The St. Albert couple has been involved in the fight to get better coverage since their daughter Eleanor was diagnosed with a severe cow’s milk allergy and prescribed an amino-based infant formula called PurAmino in December.
While the family recently won their appeal with the Alberta School Employee Benefit Plan to have the formula covered, Natalie Trinh continued to work with the government to come up with better coverage options for families like hers.
“I didn’t feel like this was ever just for Eleanor,” said Natalie. “I always felt like this was something all Alberta families deserved. I strongly felt that all babies deserve to have what they medically need and have it covered.”
The majority of insurance providers do not cover infant formulas, because it is considered a caloric agent. Some providers, like the Trinhs’, will make exceptions under special circumstances.
For families whose providers won’t review their stance, the government coverage gives them another option – other than paying full-price and out-of-pocket. although Natalie has her fingers crossed that private benefit plans will follow the province’s suit.
Currently the benefit plan only covers Neocate. Other manufacturers have made submissions to be considered and could be added to the Alberta Drug Benefit List in the future. Alberta Health spokesperson Laura Ehrkamp said it was a matter of making the benefits available as soon as possible.
According to estimates by the manufacturer of Neocate, the province’s decision will benefit between 18 to 20 infants annually.
Milk protein is among the most common food allergens. According to Health Canada, milk allergies affect up to four per cent of infants, although most outgrow them after around three years.
To be eligible for coverage, families must apply for the government’s non-group coverage to receive the benefit and are required to pay a monthly premium ranging from $82 to $118 and a co-payment of up to $25 per prescription.
Neocate costs about $690 per month. The new benefit plan could cut the cost of a 100-day supply by up to two-thirds.
The formula is only available under special authorization and must be prescribed by or in consultation with a pediatrician, neonatologist or a pediatric gastroenterologist.
