Formula for Infants, Children & Women Infant Formula - - PDF document

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Formula for Infants, Children & Women

Infant Formula Classifications

Specialty Formulas

• Extensively

Hydrolyzed Protein

• Free Amino Acid
• Lactose‐Free
• Preterm Infant
• Preterm Discharge
• Lower Mineral

Specialty Formulas

• Extensively

Hydrolyzed Protein

• Free Amino Acid
• Lactose‐Free
• Preterm Infant
• Preterm Discharge
• Lower Mineral

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Carbohydrate

• Lactose

Natural mammalian carbohydrate Requires lactase, produced at the tips of the microvilli

• Sucrose
• Corn derived carbohydrates

Complex Simple

IFF: Formula Fed Infants IFF: Formula Fed Infants

Age

1 2 3 4 5 6 7 8 9 10 11 ≥1 year

Food Enfamil Infant Formula 12.5 oz

9 9 9 9 10 10 7 7 7 7 7 7 10

Infant cereal 24 oz.

x x x x x x

Baby fruit & veg. 32- 4 oz. jars or 16 jars & $4 F&V

x x x x x x

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Contract Formulas (Class I)

Enfamil Infant Gentlease ProSobee A.R. Reguline

• Powder (12.5oz), Conc. (13 oz), RTF (32 oz)
• NeuroPro RTF (8 oz)
• Protein: 60:40 whey casein ratio
• Ratio similar to mature breast milk
• β‐Lactoglobulin not α‐Lactalbumin
• Carbohydrate: Lactose (100%)
• Prebiotics for normal gut flora
• GOS – galacto‐oligosaccharides
• Polydextrose
• DHA/ARA fatty acids
• Worldwide average levels
• Supports mental, visual, and immune development

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Gentlease

• Powder (12.4 oz)
• NeuroPro RTF (8 oz, 32 oz)
• Indication: fussiness and gas
• Protein: partially hydrolyzed non‐fat cow’s milk
• 60:40 whey casein ratio
• Uses soy based enzymes
• Not hypoallergenic
• Carbohydrate: 80% Corn Syrup Solids + 20% Lactose
• Low lactose formula
• No prebiotics
• DHA/ARA fatty acids

Reguline

• Powder (12.4 oz) only
• Indications: softer stools
• Protein: Partially hydrolyzed non‐fat cow’s milk
• 60:40 whey casein ratio
• Uses soy based enzymes
• Carbohydrate: 50% Maltodextrin + 50% Lactose
• 2 Prebiotics:GOS/Polydextrose
• DHA/ARA fatty acids

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AR: Added Rice Starch

• Powder (12.9 oz), RTF was discontinued in 2020
• Indication: Thickened consistency to reduce frequent spit ups
• Protein: 20:80 whey casein ratio
• Carbohydrate:
• Rice starch (29% in powder; 20% in RTF)
• Lactose (59% in powder; 66% in RTF)
• Maltodextrin (12% in powder; 14% in liquid)
• 2 Prebiotics: GOS/Polydextrose
• DHA/ARA fatty acids

SK(5

Prosobee: Soy

• Powder (12.9 oz) conc. (13 fl oz), RTF (32 oz)
• Indications: galactosemia, lactose intolerance or vegan diet
• Do not use for preterm infant < 4 lbs (1.8 kg) birth weight
• No proven to be hypoallergenic
• Use with caution for cow’s milk allergy
• Protein: soy
• Carbohydrate: 54% corn syrup solids
• DHA/ARA fatty acids

SK(6

Slide 9 SK(5 Need new image

Sarb, Kevin (DHHS), 7/5/2018

Slide 10 SK(6 Need new image

Sarb, Kevin (DHHS), 7/5/2018

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Class II formulas (Extensively Hydrolyzed)

Nutramigen: Conc. (13 fl oz), RTF (32 oz) Nutramigen w/Enflora LGG : Powder (12.6 oz) Pregestimil: Powder (16 oz) Alimentum: Powder (12.1 oz), RTF (32 oz)

 Requires MDF (Medical Documentation Form‐

Special Formula/Food Request Form)

 CPA can approve formula/food package  Alimentum RTF is Corn free

Class II: Only Expiration Date is Required for Each Row. Each Row should have the same Expiration Date. Do NOT check “Approved Box” for class II.

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CLASS III FORMULAS

• Automatically Makes Client High Risk

Check High Risk BOX on Nutrition & Health Summary Screen

• Must Have MDF Along With Appropriate Diagnosis
• ONLY RDs can approve
• Examples:
• Peptamen Junior
• Similac Neosure
• Pediasure
• Boost

Authorized Formulas: 6/1/2020

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Abbreviations and Footnotes:

(Bottom of Authorized Formula Form)

• 1. MDF: Michigan.gov/wic
• 2. Retail products ("R") : shelf stock items available via WIC

grocery vendors. Institutional products ("I") may require a special order. Available via WIC pharmacy vendors.

• 3. Purchase Quantity: WIC staff are recommended to assign

formula amount in multiples of the quantities listed here, when applicable. e.g.: A formula with a monthly maximum of 113 cans, that is only available in a 6‐pack (Purchase Quantity = 6), would result in a maximum purchase quantity of 108.

SK(10

When can you give RTF (Ready to Feed)?

• Documented unsanitary or

restricted water supply

• Poor refrigeration
• Caretaker has difficulty in correctly

diluting powder or liquid concentrate.

• Product in ready to feed form only

Slide 15 SK(10 Need footenotes 4-7

Sarb, Kevin (DHHS), 7/5/2018

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RTF: 2 Additional Special Conditions in POLICY 7.03 when a client is receiving a food pkg for qualifying conditions

• It better accommodates the client’s condition
• Improves the participant's compliance in

consuming the prescribed WIC formula. Select RTF in the most economical container size to meet the needs of the client.

• MI‐WIC Policy 7.03

Additional Formulary Details in MI‐WIC

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Additional Formulary Details in MI‐WIC

Formulas for Preterm Infants

Enfamil Premature 24 & Similac Special Care 24 ‐ Only for infants up to 8# ‐ 2 oz. RTF bottle ‐ 24 Cal/oz. ‐ Calcium & Phosphorous can precipitate in soft tissue if given to infants weighing more than 8#

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For Prematurity or LBW (I, C1)

Provides more: Protein, Vitamin‐K, Phosphorous & Calcium

1.

Similac Neosure 22 Cal 13.1 oz. can Pow. 32 fl. Oz. RTF

2.

Enfamil Enfacare 22Cal 8 oz. 6 pack RTF

• 3. Enfamil Neuropro Enfacare 22 Cal (10/2018)

12.8 oz. Pow Includes MFGM – Milk Fat Globule Membrane * They should NOT be used for just providing more calories

Food Package for Qualifying Conditions ‐ allows authorization of:

• EleCare Infant
• Enfaport
• Similac PM 60/40
• Neocate Infant
• Neocate Syneo

For premature infants up to 1 year GAA (Gestational Adjusted Age)

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EleCare Infant

• Severe food allergies
• 1/3 fat MCT
• Milk & soy protein free,
• Lactose, fructose & galactose free
• Gluten free
• Protein source: 100% amino acids (AA)
• Carb: corn syrup solids
• Fat: high oleic safflower, MCT, soy oils

http://abbottnutrition.com/brands/products/elecare

Neocate Infant

• For food protein intolerance
• Lactose free, Elemental
• Hypoallergenic
• 100% amino acids (AA)
• AA profile similar to breastmilk
• SBS (Short Bowel Syndrome)
• EOE (eosinophilic esophagitis, malabsorption, GERD,

food allergy

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Neocate Syneo Infant (Infants & C1)

• Hypoallergenic formula with prebiotics & probiotics,
• Treated for:

Cow Milk Allergy (CMA), Multiple Food Allergies (MFA) GI & Allergic Conditions: FPIES (Food Protein‐Induced Enterocolitis Syndrome) EOE (Eosinophilic Esophagitis) GERD

Enfaport

• Lactose free, gluten free
• High in MCT oil, easier fat absorption
• High protein
• DHA, ARA
• Chylothorax of LCHAD deficiency

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Similac PM 60/40

• Impaired renal function (low mineral intake)
• Kosher, low iron, milk‐based
• 60:40 whey to casein ratio
• Ca:P ratio designed to Tx both hypercalcemia

and hypocalcemia due to hyperphosphatemia

• Carb: lactose (100%)
• Low Iron

PurAmino Jr

• 30 cal/fl oz powder formula
• Reformulated to update the nutrient profile:

Increased protein, calcium, phosphorus & DHA.

• They will be launching a new flavor – PurAmino Jr

Vanilla.

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Infant formulas that Must be customized

The only infant formulas that do not have packages are:

• Enfamil Premature 24 Cal
• Enfaport
• RCF (Ross Carbo Free)
• Similac Special Care 24

The Following Pediatric & Adult RTF formulas: 8 oz – six packs

• Boost
• Boost Glucose Control
• Boost High Protein
• Boost Plus
• Ensure
• Ensure Plus

Issue in a quantity of 108 cans when the maximum is requested.

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Prescribing Specialty Formulas

• Can only prescribe WIC formulas Up to maximum allowable formula for

age/category

• Can be 2 or more formulas
• Reconstituted Volume (ounces)

IFF 6‐11 months old receiving formula and not able to eat infant foods.

• Need MDF
• Foods,

Option to assign the maximum formula allowed

• 7 cans

in this example

• Cannot be a

preference

• Need Med Doc.

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Children & Women Specialty Formulas

Need Special Formula/Food Request form completed with allowable qualifying condition/diagnosis, formula prescription & other foods allowed.

• Up to 910 ounces of formula allowed per month
• With Rx Class I, II or III formula, can receive

2% or whole milk to increase total calories

• Or can receive Infant Foods for pureed diet medical condition
• MI‐WIC Food Packages:
• C1 MAX (Whole Milk) Package + formula
• 2% (Reduced Fat Milk) Package + formula
• C1 MAX (WHOLE MILK/INFANT FOODS) + formula
• C2/C3/C4 MAX (LOWFAT MILK /INFANT FOODS/YOGURT) + formula
• C1/C2/C3/C4 MAX (SOY BEVERAGE/NO CHEESE/ INFANT FOODS) + formula

MI‐WIC: Assigning Risk codes from MDF

• Diagnosis needs to be

added as a current risk if not identified in MI‐WIC

• Update Medical

Information in the Nutrition & Health Summary Screen

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Class III (specialty) Formula Approval Process

• 1. CPA enters the Class III food package with Expiration Date
• 2. If CPA is not an RD, request Local RD or State RD

Approval by checking the box on Food Prescription screen:

Class III (specialty) Formula Approval Process cont…

• 3. RD reviews:

‐Request form (MDF) for completeness ‐Record for eligible diagnosis ‐Food package appropriate? ‐Consults with HCP IF food prescription is not clear

• 4. RD approves or denies (with a Note) request with appropriate dates
• 5. If client not identified as High Risk,

High Risk box needs to be checked on the Nutrition & Health Summary Screen.

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Rx extends past certification period

• Can I use the Formula/food request past the

end of the certification date?

• Can write note in client record of the

Expiration Date of the Class II/III formula food package.

• MI‐WIC will only allow

approval to end of current certification period.

• After RECERT is

performed, can assign the prescribed food package until the prescription expires.

Approved formula food package ends before cert period ends…

• What to do when Rx food

package does not extend through Cert end date?

• Assign Rx food package end

date to equal expiration date.

• Best Practice:

Wait for new MDF before entering another food package after expiration date of current MDF.

SK(21

Slide 38 SK(21 Sarb, Kevin (DHHS), 7/5/2018

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What if client needs more formula that what WIC can provide?

• BREASTFEED
• Food stamps, food or baby pantry
• Store brand formulas
• Class II & Class III formulas:

‐ covered by Medicaid or CSHCS (Children’s Special Health Care Services)

• Need prior approval through physician’s office:

MPRO 1‐800‐727‐7223

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Questions