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What It Is

​The Metabolic Foods and Formulas Program was established to assist patients with inborn errors of metabolism who have:

  • No insurance;
  • Insurance that has been denied; or
  • Exhausted their insurance benefits.

The program works with durable medical equipment providers, pharmacies and university metabolic centers to help those with inborn errors of metabolism and genetic conditions receive metabolic formulas and low-protein modified food products as funding allows.

PKU Education Series

Patients who qualify for another insurance program that covers medically necessary metabolic formulas, supplements and low-protein modified food products, with or without a co-pay are ineligible for this program.

See information and videos to the right for more information.

What are Inborn Errors of Metabolism?

Some examples of inborn errors of metabolism are genetic conditions that require a special diet prescribed and monitoring by a metabolic specialist. These conditions generally affect the body's use of proteins, fats or organic acids.

The most common of these is called phenylketonuria (PKU). PKU is an inherited metabolic disorder that the body unable to break down the amino acid phenylalanine (PHE) found in all food that contains protein. PKU is a serious medical condition managed with a special PKU formula and a special diet low in whole protein and PHE.

What Happens When You Have PKU?

Too much whole protein in the diet causes unhealthy, dangerous build-up of PHE that can lead to learning problems, brain damage and other medical conditions if not well managed. 

A diet with the correct balance of food and a metabolic formula is vital for proper growth and development. Regular blood monitoring determines if dietary changes are needed. PKU formula is one of the most important parts of this special diet.

The plan for each patient is designed by a metabolic specialist and metabolic nutritionist/dietician to enhance physical and mental well-being for those with this disorder.

What Do People With PKU Need To Know?

PKU is a lifelong condition.

In addition to damage to the brain and central nervous system, women with PKU risk having babies with birth defects and intellectual disabilities PKU is not well-controlled before and during pregnancy. A woman with PKU on diet before and during pregnancy has a much better chance of having a healthy, normal baby.

Insurance Coverage

Many health insurers now cover medical formulas, supplements and some low-protein modified foods for treatment of these disorders.

However, these products must be billed and denied before a person can seek coverage through the Kentucky Metabolic Foods and Formulas Program.

If you have insurance and your metabolic claim has been denied coverage in the past, you have the right to file an appeal.

Metabolic Clinics In Kentucky