Louisiana Revised Statutes Tit. 22, § 1059.7. Required coverage for amino acid-based elemental formulas

(1) Immunoglobulin E and non-immunoglobulin E mediated allergies to multiple food proteins.

(2) Severe food protein-induced enterocolitis syndrome.

(3) Eosinophilic disorders, as evidenced by the results of a biopsy.

(4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract.

C. (1) A health coverage plan shall provide coverage pursuant to this Section on a basis no less favorable than the basis on which prescription drugs and other medications and related services are covered by the plan, and to the same extent that the plan provides coverage for drugs that are available only on the orders of a physician.

(2) A utilization review agent acting on behalf of a health coverage plan issuer may review a treating physician's determination of the medical necessity of the use of an amino acid-based elemental formula for the treatment of a covered infant or child who is diagnosed with a disease or disorder listed in Subsection A of this Section.