Formula Funding
Consider costs when selecting a formula type. Formulas tend to be 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 they have to meet the same basic requirements as name brands formulas.
Some insurance companies have absolute exclusions regarding formulas, while others will pay for nutritional formulas 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.
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
writes a letter of medical necessity (see Tips for Writing a Letter of Medical Necessity (Rifton) and Working with Insurance Companies). Many formula companies offer sample letters of medical necessity for their specialized formulas. 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 as Medicaid will not cover formulas for
all diagnoses.
There are few mechanisms available to support those who fall between the cracks. Carnation Instant Breakfast or Ovaltine are
examples of drink additives which can be a cheap alternative for the child who needs a caloric boost and added vitamins and
minerals (although these products often add calories through sugar). 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 as part of lunch (and breakfast if the child qualifies for the free
breakfast program).
Resources
Services for Patients & Families in Montana (MT)
Service Categories | # of providers* in: | MT | NW | Other states (5) (show) | | ID | NM | NV | RI | UT |
---|---|---|---|---|---|---|---|---|---|---|
Medicaid | 4 | 1 | 62 | 170 | 38 | 6 | 17 | |||
WIC Assistance | 38 | 46 | 26 | 52 | 13 | 50 |
For services not listed above, browse our Services categories or search our database.
* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.