Pediatric and Primary Care Providers: New Process for Prescribing Specialized Formulas
Effective July 1, 2026, the MO HealthNet Division (MHD) is now the primary payer for medically necessary specialized infant formulas (such as elemental, amino-acid based, or metabolic formulas). Previously, these were handled by Women, Infants, and Children (WIC) program. WIC will now only pay for standard formulas or act as a temporary safety net. Refer to Provider Bulletin 48-57 for additional information.
This policy change does not discontinue special formula coverage for any infant or child currently eligible; it simply redirects the billing to the appropriate primary payer. WIC will continue to support participants through this transition by providing formula until insurance coverage is confirmed and they begin receiving it. Health care providers should complete a Medical Documentation Form (WIC-27) and send it to the WIC clinic while the request for insurance coverage of formula is being processed.
What Providers Need To Do
Providers should not send MO HealthNet participants to the WIC clinic for specialized formulas. Instead, send the formula Prescription to a MO HealthNet enrolled Durable Medical Equipment (DME) Provider that dispenses the specialized formula prescribed (the same way you handle enteral nutrition supplies). To assist prescribers in locating specialized infant formulas, MHD is actively surveying enrolled DME providers regarding their supply capabilities. A comprehensive list of DME companies ready to fulfill these prescriptions will be made available in the "Resources" section of the MHD DME website as soon as the data is compiled.
How WIC Acts as a Safety Net
Missouri WIC is the secondary payer and will provide WIC-approved special formula up to the maximum monthly allowance when the formula meets WIC requirements and when one or more of the following apply. A participant:
- Does not have insurance.
- Is enrolled in MO HealthNet, private or military insurance, but their formula is not covered.
- Is waiting for a MO HealthNet application or formula request to be approved.
Questions?
For questions regarding DME billing, procedure codes, or prior authorization requirements for specialized formulas, please refer to the MO HealthNet DME Provider Manual or contact Provider Communications at (573) 751-2896, toll-free at (833) 222-7916, or use the Provider Communications Management option in eMOMED.
Participants should visit Welcome to Missouri WIC for additional information.