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House of Representatives
Session of 2021 - 2022 Regular Session


Posted: September 16, 2021 10:59 AM
From: Representative Wendi Thomas and Rep. Austin A. Davis
To: All House members
Subject: Insurance Coverage for Medically Prescribed Pasteurized Donor Human Milk (PDHM)
In the near future, we plan to introduce legislation requiring health insurers, as well as Medical Assistance, to provide coverage for the use of medically prescribed pasteurized donor human milk (PDHM) in inpatient and outpatient settings for medically fragile children under the age of 12 months. To qualify for coverage, the child’s mother must be medically or physically unable to produce maternal breast milk in an amount needed to meet a child’s needs.  The donor milk must also be obtained from a milk bank licensed in Pennsylvania pursuant to the Keystone Mother’s Milk Bank Act (Act 7 of 2020).

In very low birth-weight babies and in other medically compromised infants, an all human milk diet provides powerful, unparalleled protection against serious health complications that can lead to longer hospital stays, multiple medical and surgical procedures, readmissions, life-long disability, or even death, while also increasing rates of exclusive maternal breastfeeding. Donor milk is often medically prescribed for children with heart problems and other health care issues, including neonatal abstinence syndrome (NAS), which occurs when infants are exposed to opioids or other substances of abuse in utero. When a mother’s own milk is unavailable, the use of PDHM for necessary feeding or supplementation is a proven, cost effective way to improve health outcomes and lower health care costs. 
The evidence-based and medically prescribed use of donor milk clearly warrants coverage, which will help improve both short-term and long-term outcomes for the small subset of infants who have medical conditions that require human milk or who are unable to thrive on commercially available specialty formulas.  Finally, private insurance and Medical Assistance coverage will address issues associated with disparities in access to donor milk, thereby yielding significant health benefits for our most medically fragile and vulnerable infants in Pennsylvania.
Please join us in co-sponsoring this life-saving legislation.


Introduced as HB2017