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Formula Funding

Some insurance companies have absolute exclusions regarding formulas, while others will pay for nutritional formulas, but only after infancy, or if the formula is needed for a special diet (e.g., malabsorption or PKU).
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), for families with children under age 5, provides a limited selection of standard formulas in its formulary and requires a medical prescription with a valid diagnosis to provide alternative formulas. WIC does not necessarily cover all of the formula needed by infants, so caregivers may still be responsible for purchasing some.

Formula Funding for Children with Chronic Conditions

Medicaid will usually fund formula if it is going through a feeding tube. Appeals may be necessary if the formula is being taken by mouth, or is not approaching 100% of the child's caloric needs. These appeals are often successful if the clinician knows Examples of Letters of Medical Necessity (Rifton). To aid in appealing an insurance company or Medicaid, it is helpful to demonstrate that the child cannot tolerate a cheaper formula first (e.g., try PediaSure first, if the child demonstrates intolerance, this information might help with the appeal for the more expensive hydrolyzed formula). Also, the diagnosis used to request the funding is important. (e.g., Medicaid may fund formula for a diagnosis of brain malformation with oral aversions, but not for a diagnosis of autism with oral aversions).
There are few mechanisms available to support those who fall between the cracks. Carnation Instant Breakfast is a cheap alternative for the child who only needs a caloric boost. A family can apply to hospital foundations or charity programs to help with costs, and a non-profit pharmacy may be able to provide formula at a non-profit rate. Technically, the public-school system is required to supply the formula which is part of lunch (and breakfast if the child qualifies for the free breakfast program).

Brands of Formulas

Parents often ask their doctor for advice about brands. The links, below, lead to charts that list the major brands of formula and key differences among their ingredients. Formulations are generally 20 kcal/oz and contain iron, unless otherwise noted. The Medical Home Portal does not endorse a specific brand.
Cost of formula preparations, which can vary greatly, should be considered when choosing a specific formula. Formulas are generally slightly cheaper if purchased through a home care company, commissary (if a parent is in the military), or warehouses (such as Costco or Sam's Club). Store brand and generic formulas offer more reasonably priced options and have to meet the same basic requirements as name brands do.
Examples of store brands, most of which are manufactured by Perrigo Nutritionals, are:
  • Parent's Choice (Walmart)
  • Up & Up (Target)
  • Babies"R"Us
  • Berkley Jensen (BJ's)
  • Comforts for Baby (Kroger)
  • Well Beginnings (Walgreens)
  • CVS
  • Meijer (Meijer Baby)
  • Member's Mark (Sam's Club)
  • Simply Right (Sam's Club)
  • Kirkland Signature (Costco)
Although infant formulas are required to meet the requirements of the Infant Formula Act, manufacturers’ marketing claims often are not supported by clinical evidence or evaluated by the Food and Drug Administration. [Belamarich: 2015] FDA approval is only required for claims regarding formulas and their relationship to medical conditions, claims that do not reference conditions or disease (e.g., probiotics support digestive health) do not need FDA approval. [Abrams: 2015] Insufficient evidence shows that removing or reducing lactose, using hydrolyzed or soy protein or adding pre-/probiotics to formula benefits infants with fussiness, gas, or colic. [Thomas: 2010]

Resources

Tools

Formulas & Fortifiers for Premature & Low Birth Weight Infants (PDF Document 94 KB)
A chart that lists the major brands of formula and the key differences among their ingredients; created by the Medical Home Portal, last updated December 2015.

Formulas for Term Infants (PDF Document 125 KB)
A chart that lists the major brands of formula and the key differences among their ingredients; created by the Medical Home Portal, last updated December 2015.

Formulas for Toddlers & Older Children (PDF Document 168 KB)
A chart that lists the major brands of formula and the key differences among their ingredients; created by the Medical Home Portal, last updated December 2015.

Services

Food Assistance

See all Food Assistance services providers (228) in our database.

WIC Clinics

See all WIC Clinics services providers (46) in our database.

For other services related to this condition, browse our Services categories or search our database.

Authors

Author: Lynne M Kerr, MD, Ph.D. - 10/2008
Reviewing Author: Jennifer Goldman-Luthy, MD, MRP, FAAP - 12/2015
Content Last Updated: 12/2015

Page Bibliography

Abrams SA.
Is it time to put a moratorium on new infant formulas that are not adequately investigated?.
J Pediatr. 2015;166(3):756-60. PubMed abstract

Belamarich PF, Bochner RE, Racine AD.
A Critical Review of the Marketing Claims of Infant Formula Products in the United States.
Clin Pediatr (Phila). 2015. PubMed abstract

Thomas DW, Greer FR.
Probiotics and prebiotics in pediatrics.
Pediatrics. 2010;126(6):1217-31. PubMed abstract / Full Text