Local WIC agency may provide therapeutic formula if WIC therapeutic issuance requirements are met. If the health plan denies the formula, patient should take the complete prescription to their WIC site for Nutritionist evaluation. Physician must submit the required paperwork requesting the formula to the health plan. Therapeutic Formula Coverage Options Private or Military Insurance: WIC will require a prescription* as well as a letter of denial from the health plan or Medi-Cal.Ĭhoose the formula that is right for your patient.
Should your patient be denied coverage by Medi-Cal or other health insurance, WIC may provide the therapeutic formula. WIC can provide formula temporarily while coverage is pending. As part of the patient’s treatment plan, therapeutic formulas should be covered by the health plan when the clinician provides adequate medical justification. If one of WIC’s contract formulas is not appropriate for your patients, there may be a medical condition warranting a therapeutic formula. Use the appropriate WIC referral form.Ģ.Ĝomplete the form and ensure it includes the patient’s labs (hemoglobin and hematocrit, lead levels and height and weight) and is dated and signed. Pediatric Referral Use for therapeutic formula referralġ. WIC can assist with nutrition education, breastfeeding support and supplemental food. There are many reasons to refer your patients to WIC.
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