6/19/2019

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Michigan WIC Formula Update 2019

Presented by: Kevin Sarb, MS, MBA, RDN

Maggie Tignanelli, MS, RDN

MI WIC Authorized Formulas

6/19/2019

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CONTRACT INFANT FORMULAS

Class I

Enfamil Infant

Currently authorized

Not authorized

13 fl oz can Concentrate

32 fl oz bottle RTF

8 fl oz bottle RTF*

12.5 oz can Powder

32 fl oz bottle NeuroPro RTF

20.7 oz tub NeuroPro Powder

28.3 oz can NeuroPro Powder

33.25 oz tub Premium Powder

16,875 clients210 clients 17 clients 17 clients

*NeuroPro

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Enfamil Gentlease

Currently authorized

Not authorized

12.4 oz can Powder8 oz bottle RTF*

32 oz bottle NeuroPro RTF27.4 oz can NeuroPro Powder20.0 oz tub NeuroPro Powder21.5 oz tub Premium Powder

14,697 clients 17 clients*NeuroPro

Enfamil AR

Currently authorized

Not authorized

*Mead Johnson has notified us that AR RTF 8 oz bottles will be discontinued and will not be replaced by a WIC eligible product once supplies on shelf have been exhausted.

12.9 oz can Powder

8 fl oz bottle RTF

21.5 oz tub Powder

2942 clients 4 clients*

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ProSobee

Currently authorized

Not authorized

*Mead Johnson has notified us that ProSobee RTF 8 oz bottles will be discontinued and will be replaced by ProSobee RTF 32 oz bottles.

13 fl oz can Concentrate

8 fl oz bottle RTF

12.9 oz can Powder

33 clients 3 clients* 2075 clients

22 oz can Powder

Reguline

Currently authorized

Not authorized

20.4 oz tub Powder

12.4 oz can Powder

1180 clients

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Mead Johnson Infant FormulasNot Authorized

Enfamil Premium Newborn Enfamil Enspire Enfamil Sensitive

SPECIAL FORMULASExempt Infant Formulas and WIC Eligible Nutritionals (Class II and Class III)

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Boost Retail Products

Boost 8 fl oz bottle 14 clients

Boost Glucose Control 8 fl oz bottle 1 clients

Boost High Protein 8 fl oz bottle 2 clients

Boost Plus 8 fl oz bottle 4 clients

Boost Institutional ProductsBoost Breeze 8 fl oz drink box 17 clients

Boost Kid Essentials 1.5 CAL 8 fl oz drink box 13 clients

Boost Kid Ess 1.5 CAL w/ Fiber 8 fl oz drink box 1 client

• Vanilla• Chocolate• Strawberry

• Vanilla• Orange • Peach• Wild Berry• Variety

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Compleat Pediatric

Compleat Pediatric 250 ml tetra prisma 14 clients

Compleat Pediatric Reduced Calorie 250 ml tetra prisma 1 client

Elecare

EleCare for Infants 14.1 oz can Powder 210 clients

EleCare Jr 14.1 oz can Powder 149 clients

• Vanilla

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Enfamil NeuroPro Enfacare

Enfamil NeuroPro Enfacare 12.8 oz can Powder 352 clients

Enfamil Enfacare* 8 fl oz bottle RTF 2 clients

Enfamil NeuroPro Enfacare 32 fl oz bottle RTF 0 clients

*Product to be discontinued Fall 2019

Enfamil Premature 24 CalSimilac Special Care 24

Enfamil Premature 24 Cal 2 fl oz bottle RTF MJN 1 clients

Similac Special Care 24 2 fl oz bottle RTF Abbott 0 clients

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Enfaport

Enfaport 6 fl oz bottle RTF 1 clients

Ensure

Ensure 8 fl oz bottle 47 clients

Ensure Plus 8 fl oz bottle 0 clients

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Ketocal 4:1

Ketocal 4:1 300 g (11 oz) can Powder 0 clients

Ketocal 4:1 Liquid* 8 fl oz tetra prisma RTF 1 clients

*Options• Unflavored• Vanilla

Neocate Infant

Neocate Infant 400 g (14.1 oz) can Powder 28 clients

Neocate Syneo Infant 400 g (14.1 oz) can Powder 7 clients

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Neocate Junior

Neocate Junior with Prebiotics is available in Unflavored, Strawberry, Vanilla, Chocolate & Tropical options. Neocate Junior Unflavored is also available without prebiotics.

Neocate Junior (w/ or w/out Prebiotics) 400 g (14.1 oz) can Powder 26 clients

Neocate Splash

Neocate Splash 8 fl oz tetra prisma RTF 11 clients

• Unflavored• Grape• Tropical Fruit• Orange Pineapple

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Nutramigen

Nutramigen13 fl oz can Concentrate 2 clients32 fl oz bottle RTF 11 clients

Nutramigen w/ Enflora LGG 12.6 oz can Powder 1876 clients

Nutren Junior

Nutren Junior 250 ml tetra prisma 19 clients

Nutren Junior Fiber 250 ml tetra prisma 6 clients

Vanilla Vanilla

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PediasurePediasure 8 fl oz bottle 1314 clients

Pediasure w/ Fiber 8 fl oz bottle 108 clients

Pediasure 1.5 8 fl oz can 52 clients

Pediasure 1.5 w/ Fiber 8 fl oz can 25 clients

Not authorized:

Retail Institutional

Pediasure 1.0 institutional regular or with fiber

• Vanilla• Chocolate• Strawberry• Banana• Berry• Smores

• Vanilla• Strawberry

1.5 Vanilla 1.5 Vanilla w/ Fiber

Pediasure Peptide

Pediasure Peptide 1.0 8 fl oz bottle 46 clients

Pediasure Peptide 1.5 8 fl oz bottle 19 clients

• Unflavored• Vanilla• Strawberry

• Vanilla

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Peptamen JuniorPeptamen Junior 250 ml tetra prisma 15 clients

Peptamen Junior HP 250 ml tetra prisma 0 clients

Peptamen Junior Fiber 250 ml tetra prisma 3 clients

Peptamen Junior with Prebio 250 ml tetra prisma 0 clients

Peptamen Junior 1.5 250 ml tetra prisma 3 clients

• Vanilla• Strawberry

• Vanilla • Vanilla • Vanilla • Vanilla• Unflavored

Pregestimil

Pregestimil 16 oz (1 lb) can 9 clients

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Puramino

Puramino 14.1 oz can 25 clients

Puramino Jr 14.1 oz can 6 clients

• Unflavored• Vanilla

Ross Carbohydrate Free (RCF)

RCF 13 fl oz can Concentrate 3 clients

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Similac Alimentum

Similac Alimentum 12.1 oz can Powder 422 clients

32 fl oz bottle RTF 33 clientsSimilac Alimentum

Similac Neosure

Similac NeoSure 13.1 oz can Powder 934 clients

32 fl oz bottle RTF 15 clientsSimilac NeoSure

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Similac PM 60/40

Similac PM 60/40 14.1 oz (400 g) can Powder 29 clients

Thank you!

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Formula Update 2019Part 2

Maggie Tignanelli, MS, RDN

Formula tools for CPA-RDs

Accessing Special Formulas

E-Notice # 2019-39

Policy 7.02 & 7.03

Webcast Formula Growth & Feeding from 2017

Found on MPHI Archived Webcasts (scroll to the bottom)

Jan Cox & Kevin Sarb

MI WIC Formula Help

Clinic Module Help Formulary Search

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Vanilla Peptamen Junior 1.5

Currently on formulary

Nestle product

New flavor!

Institutional (pharmacy) only product

All formula flavors are available in Formulary Search

Formulary Review

WHO: Several clinical dietitians from large pediatric hospitals across the state & local agencies

WHAT: Reviewed the Michigan WIC formulary to remove infrequently used formulas & to add more commonly prescribed formulas

WHEN: Upon approval within the State office

WHY: To have what our clients need

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Example 1

Compleat Pediatric Organic Blends Flavors: Chicken-Garden Blend & Plant-Based Blend

Blenderized tube feeding for C1-C4

Indications: Feeding intolerance common in children with developmental disabilities

Example 2

Compleat Pediatric

Peptamen Junior HP

Peptamen Junior with Prebio

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Michigan WIC Authorized Formula List

Use the most up-to-date Formula List

Currently the date is October 1, 2018

Michigan.gov/wic WIC providers tab

Look for E-Notices to notify changes

How to access maximum lists

Check for E-Notices

Important to be familiar with all the columns See next slide

Footnotes

Also at the end of policy 7.03

Important to be familiar with the columns

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Formula Policies

Policy 7.02 (Authorized WIC Foods)

Food (including formula) authorization considerations

Meet federal & state criteria

Lack packaging confusion

Be commonly used by WIC clients

Availability

How Class I, II and III formulas are classified

Requirements for iron-fortified infant formula

RTF special conditions – see slide 10

Formula Policies

Policy 7.03 (Food Package for Qualifying Conditions)

Food package maximums for qualifying conditions

Food package customizations

Infants 6-11 months, who are not allowed foods, can receive class I, II or III formulas at the maximum monthly allowance of 4-5 month infant packages

Women and children > 24 months may receive whole milk if indicated on medical documentation when receiving class II or III formulas

Medical documentation requirements on Special Formula/Food Request form

Inborn Errors of Metabolism – refer to Children’s Hospital of MI Metabolic Clinic

Ask State WIC consultant for contact information

Class III formula special instructions (also in Footnotes on formulary list)

RTF special conditions – see slide 10

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Formula Policies

Ready-To-Feed (RTF) requirements in Policy 7.02 & 7.03

Types of Special Formulas

High Calorie Formulas

Enfamil NeuroproEnfacare

Similac Neosure

Similac Special Care 24

Enfamil Premature 24 cal

Extensively Hydrolyzed Formulas

• Nutramigen• Alimentum• Pregestimil

Semi-Elemental Formulas• Pediasure Peptide 1.0/1.5• All Peptamen Juniors

Amino Acid- Based Formulas

• EleCare (+ Jr)• Neocate (+ Jr)• Neocate Syneo Infant• Neocate Splash• Puramino (+ Jr)

Nutritionals• Boost (all varieties)• Boost Kid Essentials• Compleat Pediatric• Ensure (women only)• Pediasure• Nutren Junior• Pediasure (+ 1.5)

Unique Formulas• Enfaport• Ketocal 4:1• Pregestimil• RCF• Similac PM

60/40

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Breakdown of Milk Proteins in Formula

Common Qualifying Conditions

Failure to Thrive – see 2017 webcast

Preterm/LBW

Only goes up to 24 months as a risk code

Need to check high risk box if > 2 years old and receiving class III formula

Client may have a secondary diagnosis/risk code

Neonatal Abstinence Syndrome

Mixing contract formulas to desired kcal need

Cow’s milk allergy

See next slide

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Qualifying Conditions for Milk Allergy

Suitable Diagnosis Diagnosis Needs Clarification

Suspected milk protein allergy Formula intolerance

Milk protein intolerance Tolerance issues

Milk protein sensitivity Milk intolerance (milk in food package)

Severe food allergies (allergies specified) Lactose intolerance (can have soy milk)

Rule out milk protein allergy

From Policy 7.03

CPA-RD assessment of Special Formula/Food Request (SFFR) Form

Assessment:

Do we have up-to-date anthropometrics?

What food intake data was collected in Nutrition History screen?

Have they been on this formula before?

Is this formula appropriate for their qualifying condition?

If there is discrepancy, consult with the medical provider (MP)

Discuss maximums with MP

The CPA-RD has two options – approve or deny

Err on the side of caution!

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Special Formula/Food Request Form (DCH-1326)

Changes coming due to ADA (Americans with Disabilities Act) compliance

Some minor changes “Please complete ALL sections”

Supplemental Foods column split into two

Milk Substitutions has shorter explanations

Soy Beverage options include “cultural/vegan diet”

Duration has months abbreviated to MOS

Don’t forget about instructions (DCH-1325) May be helpful for WIC clients going to MP for special formula

for the first time

Preventing Access Issues Explaining how to use WIC benefits

Providing a vendor list and explaining retail vs institutional (pharmacy) formulas

Minimum stock requirements

All formulas & flavors not necessarily available

May need to special order from customer service if retail formula

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E-Notice # 2019-39

E-Notice # 2019-39 Continued

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Infant Feeding Guidelines USDA updated Infant Nutrition and Feeding

Updated April 2019

Found on https://wicworks.fns.usda.gov/

Chapter 4: Infant Formula Feeding

Hunger/satiety cues

General formula preparation tips

Common feeding concerns

Feeding tips may lead to reduced returned formula

For more tips see CPA-Guidance (E-Notice 2019-39)

Transition to whole milk at 1 years old

Inform those with infant packages > 1 years old

Policy Update !!! 8.05 Returned Formula and Re-Issuance of Benefits

Revised on 5/31/19, see E-Notice 2019-81

It’s a part of policy to educate clients on how to redeem WIC formula benefits

For each LA choosing to donate returned formula

A policy & procedure MUST be developed and approved by LA administration and/or legal counsel before donating begins

Donation/disposal of returned formula MUST be electronically documented on WIC Formula Acceptance and Action Log (8.05A)

Each LA should collect all of their clinic’s logs and attach in 1 email to send to TignanelliS@Michigan.gov

By the 3rd business day of each month until further notice

Required to encrypt email!

All LAs need to submit their Logs, whether donating, disposing or even if it is blank

LA discretion of where to document formula from satellite clinics

E-Notice reminder

Will include encryption instructions

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QUESTIONS

Email: TignanelliS@Michigan.gov

Phone: 517-335-8914