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FAQs
Frequently Asked Questions
- Who may order metabolic foods and formulas?
- How does this program work?
- I live in Kentucky and have insurance/Medicaid. Do I have to pay anything for my food or formula?
- I called in an order a week ago and still have not received it. What should I do?
- Where do these foods and formulas come from?
- I have heard of a new PKU drug. What is it and where can I find out more about it?
- What is a certificate of medical necessity (CMN)?
- What is a prior authorization (PA)?
Who do I need to ask for when calling for information?
What states are currently receiving service from Metabolic Plaza?
| 1. | Who may order metabolic foods and formulas?
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These foods are only meant for metabolic patients (individuals with PKU, MSUD, amino acid disorders, etc.). Others who eat these foods will find their diet deficient in protein, and health problems can arise. |
| 2. | How does this program work?
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| Both private insurances and the state of Kentucky only allow pharmacies to bill for reimbursement once every 30 days. Therefore, we can only accept orders once every 30 days if you're covered through one of these two. When you want to place an order, make a list of foods that will keep your kitchen stocked for an entire month. If you are a new patient, you will first need to contact us either through this website or by calling 866-260-9010. Existing patients can order their products by contacting us at 866-260-9010, faxing their orders to 606-864-1349, or through this website. Your order will be placed once we've received it from you. Please be sure to include your shipping address, telephone number and email address when placing your order. If you've placed your order through this website, a confirmation will be sent to the email address provided. |
| 3. | I live in Kentucky and have insurance/Medicaid. Do I have to pay anything for my food or formula?
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| Some insurance companies and some types of Medicaid do leave a co-pay for you to cover. If this happens, we will let you know a co-pay exists and ask you if you still want to have us order food or formula for you. Typically these co-pays range from $1 to $30, though in a few rare instances some insurance co-pays are higher. If you still want us to supply your products, we will mail you a bill with a receipt for your records. |
| 4. | I called in an order a week ago and still have not received it. What should I do?
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| If you have placed an order and have not received it within 7-10 days, give us a call. Some of the foods and formulas are not kept here in the pharmacy and must be special ordered from the company. We can obtain shipping numbers on all of our patients' orders, and can have your shipment tracked. Call if you are unsure of your order. |
| 5. | Where do these foods and formulas come from?
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| The short answer is, all over. Some of our products come from Europe (Italy, the United Kingdom, etc.). Some are made here in the USA, ranging from California to New Jersey. This is why the lag time between when you place an order to when you receive it can be as short as overnight, to as long as 10 days. Orders arrive via Fed Ex or UPS. |
| 6. | I have heard of a new PKU drug. What is it and where can I find out more about it?
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The new PKU drug is called KUVAN. The company BIOMARIN released KUVAN with FDA approval in December of 2007. KUVAN is a prescription medication and will have to be prescribed by your doctor. For more information on KUVAN visit the website at www.kuvan.com, or call your doctor and see if you may be eligible for KUVAN. |
| 7. | What is a certificate of medical necessity (CMN)?
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| A certificate of medical necessity is a form used for specific medicaid patients for reimbursement purposes. A CMN is required along with a prescription from a doctor, nurse practitioner, or other healthcare provider allowing us to bill a third party for foods, formulas, or medications. We obtain CMNs directly from providers making it easier on our patients. |
| 8. | What is a prior authorization (PA)?
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| A prior authorization is an additional step in acquiring third party coverage for some prescribed products. We are in daily contact with providers to ensure coverage of lifesaving foods, formulas, and medications. |
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Who do I need to ask for when calling for information? |
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| Ask for Kyla or Drew |
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What states are currently receiving service from Metabolic Plaza? |
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Currently, all states can order foods if they are cash paying customers. |