7/10/2020 Formula for Infants, Children & Women Infant Formula Classifications Specialty Formulas Specialty Formulas • Extensively • Extensively Hydrolyzed Protein Hydrolyzed Protein • Free Amino Acid • Free Amino Acid • Lactose ‐ Free • Lactose ‐ Free • Preterm Infant • Preterm Infant • Preterm Discharge • Preterm Discharge • Lower Mineral • Lower Mineral 1
7/10/2020 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 0 1 2 3 4 5 6 7 8 9 10 11 ≥1 year Food Enfamil Infant 9 9 9 9 10 10 7 7 7 7 7 7 10 Formula 12.5 oz Infant cereal x x x x x x 24 oz. Baby fruit & veg. x x x x x x 32- 4 oz. jars or 16 jars & $4 F&V 2
7/10/2020 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 3
7/10/2020 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 4
7/10/2020 SK(5 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(6 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 5
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
7/10/2020 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. 6
7/10/2020 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 7
7/10/2020 SK(10 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. 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 8
Slide 15 SK(10 Need footenotes 4-7 Sarb, Kevin (DHHS), 7/5/2018
7/10/2020 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 9
7/10/2020 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# 10
7/10/2020 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) 11
7/10/2020 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 12
7/10/2020 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 13
7/10/2020 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. 14
7/10/2020 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. 15
7/10/2020 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. 16
7/10/2020 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 17
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