Affording Formula

Overview

This resource provides clinicians with information and strategies to support families who need formula to feed their child. Occasionally, brand names or companies are mentioned to provide examples—the Medical Home Portal does not endorse a specific company or type of formula.

Tips for Finding the Least Expensive Formula

All regulated formulas meet the same basic nutritional requirements, so it is important to consider costs when selecting a formula type.
  • When available, powdered formula tends to be less costly than liquid concentrate or ready-to-feed.
  • Store brand and generic formulas offer more reasonably priced options than brand name formulas and are frequently made by one of the well-known brand name companies.
  • Formulas tend to be slightly less expensive if purchased through a home care company, commissary (if a parent is in the military), or warehouses (such as Costco or Sam's Club).
  • For specialty formulas that are more difficult to find in stores, buying in bulk online (AmazonSmile, etc.) can be a great option.

Using Insurance or Medicaid to Pay for Formula

Some insurance companies have absolute exclusions regarding formulas, while others will pay for nutritional formulas only after infancy or if the formula is needed for a medical indication (e.g., malabsorption, PKU, tube feeding). Many formula companies offer sample letters of medical necessity for their specialized formulas.
Insurance companies, including Medicaid, will usually fund formula if it goes through a feeding tube.
When formula is taken by mouth, formula costs are less consistently covered. An appeal may be necessary if the formula is taken by mouth to adequately meet the child's caloric needs. These appeals are often successful if the clinician writes a letter of medical necessity (see Tips for Writing a Letter of Medical Necessity (Rifton) and Working with Insurance Companies).
When a different formula is needed, an appeal is more likely to be successful if the clinician demonstrates that the child was not able to tolerate a less expensive formula first (e.g., an intolerance of PediaSure® may assist in the appeal for a more expensive hydrolyzed formula). It can be helpful to include the patient’s growth chart to demonstrate fluctuations in weight and unsuccessful formula trials in cases of faltering growth (failure to thrive) or when formula intolerance impacts growth. The diagnosis used to request formula funding is vital because insurance may not cover formulas for all diagnoses. If the appeal is rejected, it is reasonable to ask the insurer for suggestions on reworded diagnoses that might be accepted.

Discounted & Free Formula

Formula Companies

Major formula brands often have programs that offer deals and coupons (e.g., Similac’s “Strong Moms” or their program for parents of multiples (twins/triplets). Local formula company representatives might be able to help with formula samples, coupons, or specialty products. Encourage families to explore the formula’s website.

WIC

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), for families with children under age 5, provides a limited selection of standard formulas in its formulary. As a supplemental nutrition program, WIC does not cover all of the formulas infants need, so caregivers will likely need to purchase some on their own.
Typically, the state WIC program contracts with a brand-named formula manufacturer and receives rebates from the manufacturer. Due to this financial arrangement, it is advantageous to the system to use the contracted formulas as it allows more children to be served. WIC requires a medical prescription with a valid diagnosis to provide alternative formulas (including a change in brand).
If a patient is under 5 and requires a specialty formula, WIC can fulfill to their grant maximum and then they will send the remainder needed to Medicaid for coverage as a home health order.
It is a good idea to have a contact in your local WIC office to help you with the intricacies of what they provide and how to order/prescribe so parents get the maximum benefit.

SNAP

Supplemental Nutrition Assistance Program (SNAP) helps low-income families to offset the costs of formula and groceries.

Public Schools

The public school system may be willing to supply the formula as part of lunch (and breakfast if the child qualifies for the free breakfast program). This varies by state.

Not-for-Profit Options

A family can apply to hospital foundations or charity programs to help with costs, and a non-profit pharmacy may be able to provide formula at a non-profit rate. Food pantries often stock “standard” formulas and may be a good option for families with food insecurity. See Service Providers, below.

Alternatives to Expensive Formulas

There are a few mechanisms available to support those who fall between the cracks. Carnation Instant Breakfast, Ovaltine, and PediaSure drink additives are examples of relatively cheap alternatives for the child who needs a caloric boost and added vitamins and minerals (although these products often add calories through sugar). Many companies sell drinks and shakes as meal supplements or to provide nutritional variety for picky eaters. Some families supplement liquid nutrition by making smoothies at home, adding healthy ingredients like fruit, vegetables, and dairy or plant-based milks, yogurt, protein powder, nut butters, chia or flax seeds, a dash of flax or coconut oil, or avocados to round out the nutrition. Note: not all of these may be compatible with tube feeding. Refer tube-fed children to a dietician if the family plans to offer a blenderized, DIY diet.

Resources

Information & Support

For Professionals

Savings and Assistance Programs for Your Patients
Mead Johnson offers a range of savings and assistance programs to support parents when they need it most.

For Parents and Patients

Supplemental Nutrition Assistance Program (SNAP)
SNAP provides nutrition benefits to supplement the food budget of needy families so they can purchase healthy food and move towards self-sufficiency; USDA Food & Nutrition Service.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

Services for Patients & Families in Rhode Island (RI)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Initial publication: October 2008; last update/revision: October 2021
Current Authors and Reviewers:
Author: Kimberly Stowers, MD
Contributing Authors: Wendy L. Hobson-Rohrer, MD, MSPH, FAAP
Anne Woodbury, RD
Reviewers: Lisa M Smith, RN, MSN
Maria Castro Ortiz
Katie Vogt
Authoring history
2018: update: Jennifer Goldman-Luthy, MD, MRP, FAAPA
2015: update: Jennifer Goldman-Luthy, MD, MRP, FAAPA
2008: first version: Lynne M. Kerr, MD, PhDA
AAuthor; CAContributing Author; SASenior Author; RReviewer