Back to Insights and Updates for ProvidersJanuary 2024

Maine mandate and new coverage for donor breast milk

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In accordance with a recent Maine mandate (An Act to Require Private Insurance Coverage for Donor Breast Milk), effective for dates of service beginning Jan. 1, 2024, benefits for pasteurized donor breast milk will be provided for eligible infants in Maine under 12 months old, as outlined in their Harvard Pilgrim Health Care member’s Benefit Handbook.

The use of donor breast milk can be beneficial for high-risk infants, primarily low birth weight infants or those with a severe intestinal disorder. Pasteurized donor milk provides the nutritional and immunologic benefits of breast milk and reduces infectious complications in preterm or low birthweight infants compared to formula milk.

Prior authorization is not required. For additional information, please refer to the Donor Breast Milk Medical Necessity Guidelines.

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