ODH Alert: Ohio WIC Formula Updates and Prescription Form

Dear Healthcare Provider:

The Ohio Department of Health supports the infant feeding recommendations made by the American Academy of Pediatrics, Committee on Nutrition. The Ohio Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) encourages you to join us in promoting and supporting breastmilk as the optimal food and primary feeding choice for the first 6 months of life, introducing appropriate complementary foods at about 6 months of age, and continuing breastfeeding for two years or beyond.

WIC recognizes there are families of infants who cannot or choose not to breastfeed exclusively. For those families, supplemental iron-fortified formula is available through Ohio WIC. Each year there is a review of submissions for specialized products to be added to Ohio WIC’s formulary. Beginning October 1, 2022, the following products will be available for issuance from Ohio WIC with a valid prescription:

  • Fortini is indicated for term infants with increased energy needs and/or fluid restrictions due to failure to thrive, congenital heart disease, chronic lung disease, respiratory syncytial virus (RSV), neurological syndromes, or cystic fibrosis. Provides 30 calories and approximately 0.48 mg iron per fluid ounce. Typically for use up to 19.8 pounds, not intended to be used for catch-up growth for preterm infants.
  • Compleat Pediatric Standard 1.0 is a nutritionally complete, plant-based formula free of milk, soy, corn, and gluten. Indicated for children over 1 year of age with a medical condition requiring tube feeding, full diet, or oral supplementation. Provides 30 calories and approximately .51 mg iron per fluid ounce and contains 20% of fat as MCT.
  • Compleat Pediatric Standard 1.4 is a nutritionally complete, plant-based formula free of milk, soy, corn, and gluten. Indicated for children over 1 year of age with a medical condition requiring tube feeding, full diet, or oral supplementation. Provides 42 calories and approximately .71 mg iron per fluid ounce and contains 20% of fat as MCT.
  • EquaCare Jr is a nutritionally complete, 100% amino acid based formula. Indicated for children over 1 year of age with gastrointestinal impairment, severe food allergies, and malabsorption who are sensitive to extensively hydrolyzed formulas requiring tube feeding, full diet, or oral supplementation. Provides 30 calories and .59mg iron per fluid ounce and contains 33% of fat as MCT.
  • Essential Care Jr is a nutritionally complete, 100% amino acid based, low FODMAP formula. Indicated for children over 1 year of age with gastrointestinal impairment, severe food allergies, and malabsorption who are sensitive to extensively hydrolyzed formulas requiring tube feeding, full diet, or oral supplementation. Provides 30 calories and .39mg iron per fluid ounce and contains 35% of fat as MCT.
  • Kate Farms Pediatric Peptide 1.0 is a nutritionally complete, plant-based, peptide-based formula free of milk, soy, corn, and gluten. Indicated for children over 1 year of age with gastrointestinal impairment and/or malabsorption requiring tube feeding, full diet, or oral supplementation. Provides 30 calories and .41 mg iron per fluid ounce and contains 50% of fat as MCT.
  • Kate Farms Pediatric Peptide 1.5 is a nutritionally complete, plant-based, peptide-based formula free of dairy, soy, corn, and gluten. Indicated for children over 1 year of age with higher calorie needs due to gastrointestinal impairment and/or malabsorption requiring tube feeding, full diet, or oral supplementation. Provides 45 calories and .59 mg iron per fluid ounce and contains 40% of fat as MCT.
  • Kate Farms Pediatric Standard 1.2 is a nutritionally complete, plant-based formula free of milk, soy, corn, and gluten. Indicated for children over 1 year of age with a medical condition requiring higher calorie needs and tube feeding, full diet, or oral supplementation. Provides 36 calories and approximately .41 mg iron per fluid ounce and contains 40% of fat as MCT.
  • Kate Farms Standard 1.0 is a nutritionally complete, plant-based formula free of milk, soy, corn, and gluten. Indicated for children over 1 year of age and women with a medical condition requiring tube feeding, full diet, or oral supplementation. Provides 30 calories and approximately .45 mg iron per fluid ounce and contains 35% of fat as MCT.
  • Peptamen Junior PHGG is a nutritionally complete, lactose-free, gluten-free, 100% whey protein, peptide-based formula with prebiotic fiber PHGG. Indicated for children over 1 year of age with gastrointestinal impairment and/or malabsorption requiring tube feeding, full diet, or oral supplementation 36 calories and .47 mg iron per fluid ounce and contains 60% of fat as MCT.
  • Store Brand Hypoallergenic Infant Formula is a nutritionally complete, extensively hydrolyzed, lactose-free formula. Comforts (Kroger), Meijer Baby, Parent’s Choice (Walmart), and Tippy Toes (Giant Eagle and other stores) are authorized on Ohio WIC. Indicated for infants and children with cow’s milk protein allergy. Provides 30 calories and .36 mg iron per fluid ounce.

Ohio WIC’s Prescribed Formula and Food Request Form has been revised appropriately. Please ensure that you are using the most current form with the effective date of October 2022.

As a reminder, special formulas issued by WIC must be prescribed for their specific nutrient content related to treatment of a medical condition. Prescription requests for special formulas must still contain all of the following information:

  • Participant’s name and date of birth.
  • Amount of formula to be provided per day (must be a specific, measurable volume).
  • Intended length of use of the formula (not to exceed six months).
  • Documented medical diagnosis (must relate to the special formula requested).
  • Name of formula.
  • Any contraindications for other supplemental foods that WIC provides.
  • Signature, credentials, and telephone number of the prescribing health care provider.
  • Date prescribed.

WIC cannot approve a special formula request if the formula:

  • Prescription does not include the minimum information outlined in this letter.
  • Does not meet WIC requirements for issuance.
  • Is prescribed solely for weight management or nonspecific “intolerance.”

WIC health professionals will work with healthcare providers to obtain any missing data and provide expedient service to participants. The health professionals in the WIC clinics make decisions related to the issuance of formulas and foods based on WIC policy and an individualized nutrition assessment.

Please note that due to the infant formula shortages, Ohio WIC will continue to offer several flexibilities, including more formula options (brands and container sizes) for standard milk and soy-based infant formula. Per the USDA, Mead Johnson products will be available through December 31, 2022, and other brand infant formula will be available through October 31, 2022, unless otherwise indicated. A list of formula alternatives and options is available at www.odh.ohio.gov/wic.

Additionally, for prescribed formulas, healthcare providers may select the top two to three formulas that meet the participant’s nutritional needs indicating first, second, and third recommended formulas, as appropriate. WIC health professionals will work collaboratively with WIC participants to determine which option will be issued to the WIC Nutrition Card.

Thank you for your continued support of the Ohio WIC program. If you should have any questions, please contact your local WIC office.

Sincerely,
Sean Keller, Interim Director
Ohio WIC Program

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