Therapeutic Formulas (Prescription Required)


If one of WIC's standard contract formulas is not appropriate for your patient, there may be a medical condition warranting a therapeutic formula. Please review procedures for prescribing therapeutic formula here.


Similac® Alimentum® Powder 


Milk based. Hypoallergenic formula for cow and/or soy protein allergies. Proteins are broken down into tiny pieces for easier digestion.

Indications/Used for

  • Cow milk protein allergy
  • Soy protein allergy
  • Protein sensitivity, colic, severe diarrhea, and rashes

Calories per ounce: 20 cals./ oz.

Nutramigen® with Enflora™ LGG® Powder

Nutramigen® with Enflora™ LGG® Powder


Milk based. Hypoallergenic formula for cow milk protein allergy and conditions with malabsorption. Proteins broken down for easier digestion.

Indications/Used for

  • Cow milk protein allergy
  • Soy protein allergy
  • GERD
  • Malabsorption

Calories per ounce: 20 cals./ oz.

Enfamil® NeuroPro EnfaCare® Powder

Enfamil® NeuroPro EnfaCare® Powder


Milk based. Increased vitamins and minerals. Increased calories for growth. Milk Fat Globule Membrane (MFGM) and DHA to support brain development.

Indications/Used for

  • Premature infants born ≤ 37 weeks gestation

Calories per ounce: 22 cals./ oz.

Nutramigen® Concentrate


Milk based. Hypoallergenic formula for cow milk protein allergy. Proteins broken down for easier digestion.

Indications/Used for

  • Cow milk protein allergy
  • Colic

Calories per ounce: 20 cals./ oz.

Similac NeoSure® Powder

Similac NeoSure® Powder


Milk based. Increased protein, energy, vitamins, and minerals compared to term infant formulas. Extra calories for growth.

Indications/Used for

  • Premature infants born ≤ 37 weeks gestation

Calories per ounce: 22 cals./ oz.

PEDIASURE GROW & GAIN SHAKE

PediaSure Grow & Gain Shake (Vanilla)


Provides additional calories for children with food restrictions. Additional dietary support for children with lactose and gluten intolerance.

Indications/Used for

  • For children 1 year and older.

Calories per ounce: 30 cals./ oz.

WIC Standard Formulas (No Prescription Required)


WIC infants not exclusively breastfed or receiving breastmilk may be issued the following infant formula. A prescription is not required for these formulas.


Enfamil® Infant

Enfamil® Infant


Milk based. Iron-fortified for full-term infants.

Indications/Used for

  • Full term healthy infants

 

Calories per ounce: 20 cals./ oz.

Enfamil® ProSobee®

Enfamil® ProSobee®


Soy plant protein based, milk-free, lactose-free.

Indications/Used for

  • Lactose intolerance
  • Fussiness and gas as a result of sensitivity to milk-based formula
  • Vegan dietary practices

 

Calories per ounce: 20 cals./ oz.

Enfamil® Gentlease®

Enfamil® Gentlease®


Reduced lactose. Milk protein blend similar to breast milk that has been partially broken down.

Indications/Used for

  • Fussiness and gas
  • Colic
  • Transition formula from breast milk feedings

 

Calories per ounce: 20 cals./ oz.

Enfamil A.R.™

Enfamil A.R.™


Milk based with added rice starch. Increases viscosity in the bottle 10x that of routine formula. Rice starch forms a bolus in stomach to reduce amount of free liquid.

Indications/Used for

  • Excessive spitting up
  • GERD

 

Calories per ounce: 20 cals./ oz.

Enfamil® Reguline®

Enfamil® Reguline®


Cow milk based with prebiotics and partially broken down proteins.

Indications/Used for

  • Constipation
  • Difficult stools

 

Calories per ounce: 20 cals./ oz.

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