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WIC Formula Issuance Policies

DOWNLOADABLE HANDOUT: Standard Infant Formula Guidelines Brochure

DOWNLOADABLE HANDOUT:  Common WIC Formulas and Indicated Uses

Click here for a full list of formulas NOT approved on KY WIC Program

Click here: WIC Formula Frequently Asked Questions

 

Issuance of Contract Brand Formula

The infant formula rebate contract is with Gerber. All infants who are not medically fragile must be provided Good Start Gentle Stage 1. This is the contract brand primary milk based standard formula and must be the first formula tried.

The contract brand standard formulas that are appropriate to provide to infants during the first year of life are:

a. Good Start Gentle Stage 1  (primary formula) (orange can)
b. Good Start Soothe Stage 1 (purple can)
c. Good Start Soy Stage 1(blue can)

Guidelines for Transitioning Infants to
Contract Brand Formula

Counseling must include information about changing the infant from the current formula to the contract brand formula. The counseling guidelines for formula transition are as follows:

What to do if my baby’s formula is changed:

  • First day: Offer infant ¾ of current formula mixed with ¼ of the Challenge (new) formula (ie. 3 ounces current formula plus one ounce of challenge formula)
  • Second day: Offer infant ½ current formula and ½ challenge formula
  • Third day: Offer infant ¼ current formula and ¾ challenge formula
  • Fourth day: Offer infant challenge exclusively

Formulas Requiring A Prescription:

Any formula other than Good Start Gentle, Soothe, or Soy requires a doctor’s order on the Kentucky WIC Medical Necessity Form and must include:

  • Complete name of specific formula;
  • Valid diagnosis;
  • Length of time baby is to receive formula; and
  • Signature of MD, DO, APRN, PA.

Blank Medical Necessity Forms may be requested by physician’s offices by contacting the health department. The forms can be faxed or mailed to the physician’s office.

Be aware that WIC requires retrials with WIC Contract Formulas unless medically contraindicated. If a request is approved for a standard noncontract formula (like Enfamil or Similac), WIC will automatically provide a standard contract formula for retrial at the end of the approved time period (1 to 3 months), unless an appropriate reason is indicated on the request form.

Example: WIC approves a request for Enfamil Premium for 3 months. At the end of the 3-month approval period, WIC will issue the comparable contract formula,Good Start Gentle, for retrial, along with instructions for making a transition to the new formula.

If a retrial with a standard contract formula is medically contraindicated, please provide the reason on the Medical Request Form for Formula/Food.

Formula Trails/Challenge Guidelines

Please Note: Challenge formula must be tried for 72 hours or 3 days exclusively following the transition phase. Some exceptions are severe reactions, such as rash, projectile vomiting, a medically fragile infant, or professional judgment.

Infants who come to clinic on non-contract formula and are not medically fragile must be provided the Good Start Gentle using the following challenge guidelines:

  1. Infants who come to clinic on one of the contract brand formulas, Good Start Soy, or Good Start Soothe, must have tried and encountered problems with Good Start Gentle unless contraindicated.  See First Trial.  The patient then may try any of the remaining contract brand products.  See Second Trial.

    First Trial: Good Start Gentle (orange can)

    Second Trial:
    Any one of the remaining contract brand products:
    Good Start Soothe (purple can) or others

  1. If requesting noncontract brand milk-based formula (Similac Advance Stage 1, Enfamil Premium Infant, etc.), the patient must have tried the contract brand iron-fortified formulas below, unless contraindicated and encountered problems:

    First Trial: Good Start Gentle Stage 1 (orange can)

    Second Trial: Good Start Soothe Stage 1

  1. If requesting Kosher or Halal formula due to religious beliefs (Similace Advance Stage 1, etc), the patient must have tried the contract formula and encountered problems:

    First Trial: Good Start Soy Stage 1 (blue can) (unless contraindicated)

  2. If requesting noncontract soy-based formula (Enfamil ProSobee or Similac Soy Isomil, etc.), the patient must have tried the contract brand soy-based formulas below, unless contraindicated, and encountered problems:

    First Trial: Good Start Soy Stage 1 (blue can)

    Second Trial:
    Good Start Soothe Stage 1 (purple can) (if no milk allergies exist)

  1. If requesting milk-based lactose free or lactose reduced formula (Enfamil Gentlease, etc.), the patient must have tried the Contract brand formulas below, unless contraindicated, and encountered problems.

    First Trial:
    Good Start Soothe Stage 1 (purple can)

    Second Trial:
    Good Start Soy Stage 1 (blue can)
  1. If requesting a formula for management of reflux or gastroesophageal Reflux (GER) or gastrophageal reflux disease (GERD), no contract formulas are comparable and the noncontract products may be provided with a valid WIC-200. This includes the following formulas: Enfamil AR.
  1. If requesting noncontract milk based products for 9 to 12 months of age (Similac Go and Grow, Enfagrow Toddler Transitions), the patient must have tried the contract brand formulas below, unless contraindicated, and encountered problems:

    First Trial: Good Start Gentle Stage 1 (orange can)

    Second Trial: Good Start Soothe Stage 1 (purple can)

  1. If requesting soy based products for 9 to 12 months of age (Enfagrow Toddler Transitions Soy, etc), the patient must have tried the contract brand formulas below, unless contraindicated, and encountered problems.

    First Trial: Good Start Soy Stage 1 (blue can)

    Second Trial: Good Start Soothe Stage 1 (purple can) OR Goodstart Gentle Stage 1 (orange can) (if no milk allergies exist)

Ready to Feed Formula

Ready to Feed (RTF) Formula can only be given for one of the following reasons:

  • Poor water supply
  • No refrigeration
  • Unable to mix the formula properly
  • Only form available of the product

If the family is getting drinkable water, then concentrate or powder formula will be provided.

Formulas NOT AUTHORIZED by the Kentucky WIC Program

  • Enfamil Newborn
  • Enfamil Enspire
  • Enfamil for Supplementing

(The following are only 19 kcal/ounce which does not meet the minimum guidelines for calories)

  • Similac Pro-Advance
  • Similac Sensitive
  • Similac for Spit Up
  • Similac Pure Bliss
  • Similac for Supplementation