Amid broad support from medical community, donor breast milk bill attracts questions over cost, regulatory oversight
Neonatal doctors, hospitals and donor breast milk companies testified Monday in favor of a bill they said would greatly reduce the number of premature babies in Nevada that die from serious intestinal disease, though questions remain over the cost of the proposal.
The bill, which was heard by the Senate Health and Human Services Committee, would require the state’s Medicaid program to cover the cost of donor breast milk and human milk fortifier for premature babies with a birth weight of 1,500 grams or less or those suffering with intestinal issues. But the legislation, SB115, comes with a nearly $9 million price tag, something that state Sen. Scott Hammond, the bill’s sponsor, and other supporters argued would be well worth the savings in the long run.
“Nowhere in [Medicaid’s] calculations do I see a consideration of the reduction in cost because of improved infant health, shorter hospital stays, and reduced need for outpatient services,” Hammond said
During the hearing, Dr. Deepa Nagar, medical director of the neonatal intensive care unit at Dignity Health St. Rose Dominican Hospital's Siena campus, cited studies showing that the most serious cases of necrotizing enterocolitis (NEC), a disease affecting premature babies in which the walls of the intestine are invaded by bacteria that can ultimately destroy the bowel, can cost between $300,000 and $660,000 to treat per patient. At that rate, the cost to the state of providing donor breast milk, which has been shown to reduce the risk of the disease, would pay for itself if the state prevented even a small number of cases of the disease, she said.
“Preventing 15 cases of surgical NEC would justify the cost of the fiscal note alone,” Nagar said. “That means preventing a handful of cases of surgical NEC and its associated suffering for the baby and the family.”
Another neonatologist, Dr. Rebecca Perry, told the committee that a baby died from the disease while she was on call last weekend. In addition to saving lives, donor breast milk can help lessen the length of hospital stays for premature babies, she said.
“It is a terrible thing that, as a neonatology, we try our best to minimize,” Perry said.
Two donor breast milk companies, Medolac and Prolacta Bioscience, also testified in support of the legislation, as did Planned Parenthood and the Children’s Advocacy Alliance.
Medicaid director Suzanne Bierman said the state recognizes the benefits of breastfeeding and recommends it as a best practice. She also acknowledged that Medicaid’s $8.9 million estimate may be overstated.
“It really depends on some foundational questions we have around the scope of these services,” Bierman said.
But Bierman also raised concerns about the cost of the state providing oversight of donor breast milk, which isn’t currently regulated by the Food and Drug Administration.
State Sen. Julia Ratti, the chair of the committee, questioned during the hearing whether the legislation would actually expand a service to help premature babies or if it would simply shift its funding source. Two hospital systems, Dignity Health and HCA Healthcare, testified at the hearing that they already offer donor breast milk in their neonatal intensive care units in Nevada.
“What I’m really wanting to dig into is are we really moving the needle or if they’ve figured out how to fund it another way,” Ratti said.
Nagar said that her hospital provides donor breast milk and fortifier to every patient that meets the criteria at no cost but acknowledged not all hospitals do.
“Our hospital system pays for it because we feel it is that important and we spend the extra money because we know it reduces overall cost,” Nagar said. “Not every single hospital system in our state currently is able to afford this cost, so every hospital system has different criteria for which patients are eligible to get it.”
Lawmakers also heard two proposed amendments to the bill during the hearing. One would add physician assistants to the list of prescribers allowed to order donor breast milk and include coverage of human milk fortifier in the bill.
If approved by lawmakers, Nevada would join California, Texas, Missouri, Kansas, Utah, New York and the District of Columbia in covering breast milk for low-income babies.