MassHealth has allowed and will continue to allow formula to be dispensed by pharmacy providers without Prior Authorization (PA). MassHealth strongly encourages prescribers to write down any appropriate substitute products on the prescriptions for formula, in addition to the preferred product. In each case, a valid prescription is required.

These items were added to the MassHealth Non-Drug Product List. WIC participants who are MassHealth members will be guided to receive special formulas through their MassHealth insurance.Įffective May 17, 2022, in response to the formula shortage, MassHealth expanded coverage for formula dispensed through pharmacies to include all medically necessary formula. MassHealth has primary responsibility for payment of special formulas for MassHealth members who are eligible to receive benefits through the WIC Program. Instructions for Completing the RSFF Form (PDF) | (DOCX).Massachusetts WIC Nutrition Program Request for Special Formula and Food and instructions for completion (PDF) | (DOCX).

For example, for a condition associated with a need for hypoallergenic formula, providers should list Nutramigen, Alimentum, Good Start Extensive HA or other similar hypoallergenic formula as appropriate on the Request for Special Formula and Food form. Please note: To support special formula access for families during the formula shortage, it is recommended that health care providers list all formulas on the request that would be appropriate for the documented need. A thorough dietary assessment and counseling will be provided by a WIC nutritionist to resolve more common conditions not requiring special formulas such as constipation, spit-up or loose stools. To request a special formula, you will need to complete the Massachusetts WIC Nutrition Program Request for Special Formula and Food and instructions for completion (PDF) | (DOCX) to document the diagnosis warranting a medical need for the formula.

WIC offers over 45 special formulas for participants with special medical needs.

Wic formula list