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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

LOCAL PHYSICIANS OFFICES MAY CONTACT OUR OFFICE TO REQUEST WIC FORMULA MEDICAL NECESSITY FORMS AND A COPY OF OUR ENTIRE WIC FORMULA ISSUANCE POLICY.  

Issuance of Contract Brand Formula

The infant formula rebate contract is with Similac. All infants who are not medically fragile must be provided one of the WIC Contract Similac formulas. 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. Similac Advance

b. Similac Total Comfort (partially hydrolyzed protein for fussiness and gas)

c. Similac Sensitive (has intact proteins, but lower lactose levels). 

d. Similac for Spit Up

e. Similac Soy Isomil (due to the increased incidence of osteopenia, soy formulas should not be used for preterm infants)

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

    First Trial: Similac Advance

    Second Trial: Similac Total Comfort

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

    First Trial: Similac Soy Isomil

    Second Trial:
    Similac Sensitive or Similac Total Comforts (if no milk allergies exist)

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

    First Trial: Similac Total Comfort

    Second Trial:
    Similac Sensitive or Similac Soy IsomilIf requesting a formula for management of reflux or GER/GERD (ex. Enfamil AR, etc.), the infant must have tried the contract brand formula below, unless contraindicated, and encountered problems

      4. If requesting a formula for management of reflux or GER/GERD (ex. Enfamil AR, etc.), the infant must have tried the contract brand formula below,                                unless contraindicated, and encountered problems
          First Trial: Similac for Spit Up
 
     5. If requesting noncontract milk based products for 9 to 12 months of age (Enfagrow Toddler Transitions), the patient should be provided the contract                                 brand formulas below, unless contraindicated and encountered problems:

          First Trial: Similac Advance

          Second Trial: Similac Total Comfort

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

          First Trial: Similac Soy Isomil

          Second Trial: Similac Sensitive or Similac Total Comforts (if no milk allergies exist)

Hypo-allergenic Formulas

WIC provides several formulas that are hypoallergenic.  The medical necessity form must indicate the type of allergy the infant has and WIC requires that the infant be re-assessed by the physician after 3 months. 

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
  • Similac Pro-Advance
  • Similac Pure Bliss
  • Similac for Supplementation
  • (an extensive list of formulas not approved by the Kentucky WIC Program can be found for download at the top of this page.)