2019 formula update final 6.7.19 · 2019. 6. 19. · similac neosure similac special care 24...
TRANSCRIPT
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 [email protected]
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