October 1, 2012 Letter #: All WIC Project Directors MAF Michele A. Frizzell, RD, MBA, Chief, Bureau of Nutrition Services

Transcription

1 October 1, 2012 Letter #: TO: FROM: All WIC Project Directors MAF Michele A. Frizzell, RD, MBA, Chief, Bureau of Nutrition Services SUBJECT: Physician and Hospital Packets for Fiscal Year 2013 There are two formulas being added to the Ohio WIC formulary beginning October 1, 2012: Pediasure Peptide 1.5 and Compleat Pediatric Reduced Calorie. Pediasure Peptide 1.5 is a calorically dense formula for children ages 1-13 with malabsorption or other GI issues. It is available in 8 ounces RTF and can be used as an alternative to Peptamin Jr Compleat Pediatric Reduced Calorie is a tube feeding formula for pediatric patients with decreased energy needs, such as developmental disabilities, neurological impairment, or neuromuscular disorders. It is available in 8.45 ounce RTF. Also beginning October 1, a prescription is no longer required to issue coupons for Similac Sensitive and Similac for Spit-Up formulas. Once it is approved, local staff is strongly encouraged to review revised policy Section 311 for more information about documentation standards. There will also be a Health Professional Newsletter issued shortly that will provide local staff with more information regarding these changes. In summary, Similac Sensitive may now be issued if there is documentation on the health history form that the parent/caregiver has reported that the infant has been diagnosed with lactose intolerance by a physician, or the parent/caregiver verbally reports that the infant experiences symptoms of lactose intolerance (diarrhea, fussiness, excessive gas, abdominal bloating) when age appropriate amounts of formula are consumed. Documentation of the medical reasons for issuance of Similac Sensitive formula must be present in the participant s chart. For Similac for Spit-Up, documentation is also required for the medical reasons the formula is being provided. Appropriate reasons to issue Similac for Spit-Up include: the parent/caregiver reports that the infant has been diagnosed with GERD by a physician, the parent/caregiver reports that the infant experiences symptoms of GERD or other associated feeding disorders, or the parent/care giver reports that the infant is on a prescribed medication for reflux. Please see policy for examples of possible other associated feeding disorders. In addition, health professionals must also assess overfeeding and feeding position as a cause for excessive spit-up first before issuing Similac for Spit-Up. This must be documented in the WIC chart and will be monitored on management evaluations.

2 A letter is attached for use in notifying area physicians of the continuation of the Ohio WIC formula rebate contract with Abbott Nutrition for Similac brand standard formulas. The revised Ohio WIC Prescribed Formula and Food Request form, both in pdf and electronic fillable versions, and the Ohio WIC Approved Formulas document are also attached. State WIC was unable to address local staff clearance comments regarding the Ohio WIC Prescribed Formula and Food Request form at this time due to time constraints. State WIC plans to address these comments at a future date. The Ohio WIC Prescribed Formula and Food Request form will become available for order in the warehouse in the near future. Until that time, please print and use this most current version of the form. All outdated versions of the Ohio WIC Prescribed Formula and Food Request form should be recycled or destroyed. The physician s letter attached to this All Projects Letter outlines the minimum documentation required and notifies the physician that WIC health professionals will be contacting them if information is missing. The letter also informs physicians that the request for a special formula may be denied if the request does not meet certain criteria. State WIC would like to remind health professionals to use Table 310A which outlines the acceptable uses for special formulas and should be useful when fielding questions from physicians. In addition, State WIC has recently been made aware of several changes involving Neocate Junior product varieties, Neocate Nutra, and Renastart. Neocate Junior products will undergo a label change, but will have no changes in can size, price, codes, or ingredients. Neocate Nutra will also undergo a label change, as well as a change in ingredients and package size. The corn starch in Neocate Nutra will be replaced with a pregelatinized rice starch. Case or package size will be changing from a 3-pack to a 4-pack case, so it is recommended for health professionals to issue the 4- can package size to any child requiring this product. A document describing the label change descriptions provided by Nutricia is attached. As a reminder, this document is to be used as a resource only and is not to be posted in the clinic. Lastly, Renastart formula is no longer being produced at this time; therefore, it cannot be issued to participants. It will not be removed from the prescription form at this time, but prescribers should already be aware of this issue. If you have any questions, please call the direct line for your Nutrition and Administrative Services (NAS) Consultant, or (614) MAF/KRM /krm Attachments - 5

3 Dear Physician: The Ohio Department of Health subscribes to the infant feeding recommendations made by the American Academy of Pediatrics, Committee on Nutrition. The Ohio Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) encourages you to join us in promoting and supporting breast milk as the optimal food and the primary feeding choice for the first 12 months of life and beyond for all infants. For those mother and infant dyads that choose not to breastfeed exclusively, iron-fortified formula is available. On October 1, 2012, Ohio WIC will continue to offer Abbott Nutrition s Similac brand standard formulas. A prescription will no longer be required for local WIC clinics to issue Similac Sensitive or Similac for Spit-Up formulas. However, these formulas still must be issued for appropriate medical reasons, and local WIC staff must follow new documentation standards. Local WIC staff reserve the right to deny the issuance of Similac Sensitive and/or Similac for Spit-Up if the request for these formulas does not meet WIC requirements for issuance. Also effective October 1, 2012, Ohio Women, Infants, and Children program (WIC) is adding Pediasure Peptide 1.5 and Compleat Pediatric Reduced Calorie to the child formulary. Pediasure Peptide 1.5 is a calorically dense formula for children ages 1-13 with malabsorption or other GI issues. It is available in 8 ounces RTF, and can be used as an alternative to Peptamin Jr Compleat Pediatric Reduced Calorie is a tube feeding formula for pediatric patients with decreased energy needs, such as developmental disabilities, neurological impairment, or neuromuscular disorders. It is available in 8.45 ounce RTF. As a reminder, special formulas issued by WIC must be prescribed for their specific nutrient content or for treatment of a medical condition. Prescription requests for special formulas must contain all of the following information: participant s name and date of birth; amount of formula to be provided per day (must be a specific volume); intended length of use of the formula (not to exceed six months); applicable ICD9 code and documented medical diagnosis (should relate to the special formula requested); name of formula; any contraindications for other supplemental foods that WIC provides; signature, credentials, and telephone number of the physician or nurse practitioner; and date prescribed. Please ensure that you are using the most current WIC prescription with the effective date of October 1, 2012.

4 WIC reserves the right to deny a special formula request if the formula: is not part of the approved WIC formulary, prescription does not include the minimum information outlined in this letter, does not meet WIC requirements for issuance, or is prescribed solely for weight management or nonspecific intolerance. WIC health professionals will work with physicians to obtain any missing data and provide expedient service to participants. The health professionals in the WIC clinics make their decisions on acceptable formulas and foods based on WIC policy and an individualized nutrition assessment. Requested information is used to ensure that the most appropriate formula and supplemental foods are provided. Thank you for your continued support of the WIC program. If you should have any questions, please contact your local WIC office. Sincerely, Michele A. Frizzell Michele A. Frizzell, RD, MBA Chief, Bureau of Nutrition Services MAF/KRM/krm Enclosures- 3

5 Ohio WIC Prescribed Formula and Food Request - Women, Infants, and Children Please complete this Ohio WIC Prescribed Formula and Food Request form in full. REQUIRED FOR APPROVAL: Patient s name (please print) Date of birth Weeks born early (if applicable) Caregiver s name (please print) Phone 1. Amount of infant/child/adult formula to be provided per DAY: Special Instructions/Comments: 2. Intended length of use: 1 month 2 months 3 months 4 months 5 months 6 months (maximum) 3. ICD-9 code:. and Medical diagnosis (please print): (Must support the need for the formula requested.) For Issuance of Soy Milk or Tofu only, ICD-9 code is not required. Must provide a valid medical diagnosis. For PKU and Metabolic Needs: WIC collaborates with the Ohio Metabolic Formula Program which supplies certain PKU and metabolic formulas prescribed by an Ohio Department of Health (ODH) approved metabolic service provider. A separate form must be completed. Please contact your WIC office for more information. 4. Prescribed Formulas: For infants, a trial with either of these formulas is required prior to ordering any of the formulas listed in the box below. Please indicate if the infant has tried either Similac Advance with Early Shield or Similac Soy Isomil formulas: Yes No Infants and Children EleCare for Infants Enfamil Nutramigen AA Similac Expert Care NeoSure Enfamil EnfaCare ( 12 mo corrected age) Enfamil Pregestimil ( 12 mo corrected age) Enfamil Enfaport Neocate Infant with DHA & ARA Similac PM 60/40 Enfamil Nutramigen w/ Enflora LGG (powder only) Neocate Nutra ( 6 mo age) Enfamil Nutramigen (liq conc & RTF only) Similac Expert Care Alimentum Infant Foods: Indicate which infant foods listed below are contraindicated or require restrictions. Infant Cereal Fruits (strained textures) Vegetables (strained textures) Do not provide any of the infant WIC foods listed Children Only Boost Kid Essentials 1.0 Cal (pharmacy) KetoCal 4:1 Liquid PediaSure with Fiber Enteral Renastart Boost Kid Essentials 1.0 Cal (retail) KetoCal 4:1 Powder PediaSure 1.5 Cal Resource Breeze Boost Kid Essentials 1.5 Cal Monogen PediaSure 1.5 Cal with Fiber Similac Advance with Early Shield Boost Kid Essentials with Fiber 1.5 Cal Neocate Junior PediaSure Peptide ( 12 mo corrected age) Bright Beginnings Soy Pediatric Drink Neocate Junior with Prebiotics PediaSure Peptide 1.5 Cal Similac Soy Isomil Compleat Pediatric Nutren Junior Peptamen Junior Super Soluble Duocal Compleat Pediatric Reduced Calorie Nutren Junior with Fiber Peptamen Junior with Fiber Vivonex Pediatric Elecare Junior Unflavored PediaSure Peptamen Junior with Prebio 1 Elecare Junior Vanilla PediaSure with Fiber Peptamen Junior 1.5 Cal E028 Splash PediaSure Enteral Portagen Adult Boost Ensure Monogen Portagen Resource Breeze Super Soluble Duocal 5. WIC Foods: Participants on Prescribed Formulas may receive the following foods offered by WIC. Please indicate the appropriateness of the following foods to accompany the prescribed formula. WIC Foods That May Be Provided (12 Months and Older, Adults) Check this box to give authority to the WIC health professional (RD/LD, RN or DTR) to prescribe the foods listed below based upon the complete nutritional assessment. Milk Substitutions: (Children Age 2 Years and Older & Adults) Indicate which foods are to be substituted for reduced fat, low fat or skim milk for the following diagnoses: Lactose intolerance, FTT, slow weight gain, low/under weight, or other qualifying conditions. Are there any contraindications or restrictions for any of these foods? Yes, specify: *Only for patients receiving a prescribed formula who require additional calories Whole milk Lactaid whole milk Cheese Milk Beans, dried peas and legumes Juice Peanut butter (Children Age 1 Years and Older & Adults) Breakfast cereal Whole grains Indicate which foods are to be substituted for whole, reduced fat, low fat Eggs (bread, brown rice, oatmeal, corn/whole wheat tortillas) or skim milk for the following diagnoses: milk allergy, severe lactose Fruits Fish (women only, as applicable) maldigestion, vegetarian/vegan diet or other qualifying conditions. Vegetables *Patient does not need to be on a prescribed formula to receive these foods. Do not provide any of the above WIC foods Soy Milk (child) Tofu (child) >4lbs Tofu (women) Health Care Provider s Name (please print) Health Care Provider s Signature Phone Date (Rev. 10/1/12) PPL 180 This institution is an equal opportunity provider. ODH

6 Common ICD-9 Codes This listing is a sample of common ICD-9 codes which support the issuance of a specialty formula for Ohio WIC participants and is not meant to be all inclusive. Infants and Children Acute Gastritis Allergic Gastroenteritis And Colitis Allergy to Milk Products V15.02 Anemia Anaphylactic Shock Due To Milk Products Celiac Disease Cleft Palate, Cleft Lip , Congenital Heart Disease Cystic Fibrosis Dermatitis Due To Food Taken Internally Developmental Sensory/Motor Delays Diabetes 250 Disorders Relating To Extreme Immaturity Of Infant , , , , (<500g, g, g, g, g) Failure to Thrive Fetal Alcohol Syndrome Gastro Esophageal Reflux Disease (GERD) Severe Lactose Intolerance Immunodeficiency Short Stature Underweight Unspecified Intestinal Malabsorption Breastfeeding, Pregnant, Postpartum Women Allergy to Milk Products V15.02 Anemia Cesarean Delivery Gestational Diabetes Hyperemesis Gravidarum Low Maternal Weight Gain Maternal Weight Loss During Pregnancy Severe Lactose Intolerance Multifetal Gestation 651 Examples of non-qualifying conditions that do NOT support WIC issuance of specialty formulas: Non-specific symptoms or diagnosis (e.g., formula/food intolerance, spitting up, colic, constipation, fussiness, and gas). Solely for the purpose of enhancing nutrient intake or managing body weight without an underlying qualifying medical condition (e.g., poor appetite, picky eater). Food or formula intolerance that can be successfully managed with the use of WIC foods or contract formulas. Parental/patient preference or food dislikes Rev PPL 176; Reissued PPL 178

7 Ohio WIC Prescribed Formula and Food Request - Women, Infants, and Children Please complete this Ohio WIC Prescribed Formula and Food Request form in full. REQUIRED FOR APPROVAL: Patient s name (please print) Date of birth Weeks born early (if applicable) Caregiver s name (please print) Phone 1. Amount of infant/child/adult formula to be provided per DAY: Special Instructions/Comments: 2. Intended length of use: 1 month 2 months 3 months 4 months 5 months 6 months (maximum) 3. ICD-9 code:. and Medical diagnosis (please print): (Must support the need for the formula requested.) For Issuance of Soy Milk or Tofu only, ICD-9 code is not required. Must provide a valid medical diagnosis. For PKU and Metabolic Needs: WIC collaborates with the Ohio Metabolic Formula Program which supplies certain PKU and metabolic formulas prescribed by an Ohio Department of Health (ODH) approved metabolic service provider. A separate form must be completed. Please contact your WIC office for more information. 4. Prescribed Formulas: For infants, a trial with either of these formulas is required prior to ordering any of the formulas listed in the box below. Please indicate if the infant has tried either Similac Advance with Early Shield or Similac Soy Isomil formulas: Yes No Infants and Children EleCare for Infants Enfamil Nutramigen AA Similac Expert Care NeoSure Enfamil EnfaCare ( 12 mo corrected age) Enfamil Pregestimil ( 12 mo corrected age) Enfamil Enfaport Neocate Infant with DHA & ARA Similac PM 60/40 Enfamil Nutramigen w/ Enflora LGG (powder only) Neocate Nutra ( 6 mo age) Enfamil Nutramigen (liq conc & RTF only) Similac Expert Care Alimentum Infant Foods: Indicate which infant foods listed below are contraindicated or require restrictions. Infant Cereal Fruits (strained textures) Vegetables (strained textures) Do not provide any of the infant WIC foods listed Children Only Boost Kid Essentials 1.0 Cal (pharmacy) KetoCal 4:1 Liquid PediaSure with Fiber Enteral Renastart Boost Kid Essentials 1.0 Cal (retail) KetoCal 4:1 Powder PediaSure 1.5 Cal Resource Breeze Boost Kid Essentials 1.5 Cal Monogen PediaSure 1.5 Cal with Fiber Similac Advance with Early Shield Boost Kid Essentials with Fiber 1.5 Cal Neocate Junior PediaSure Peptide ( 12 mo corrected age) Bright Beginnings Soy Pediatric Drink Neocate Junior with Prebiotics PediaSure Peptide 1.5 Cal Similac Soy Isomil Compleat Pediatric Nutren Junior Peptamen Junior Super Soluble Duocal Compleat Pediatric Reduced Calorie Nutren Junior with Fiber Peptamen Junior with Fiber Vivonex Pediatric Elecare Junior Unflavored PediaSure Peptamen Junior with Prebio 1 Elecare Junior Vanilla PediaSure with Fiber Peptamen Junior 1.5 Cal E028 Splash PediaSure Enteral Portagen Adult Boost Ensure Monogen Portagen Resource Breeze Super Soluble Duocal 5. WIC Foods: Participants on Prescribed Formulas may receive the following foods offered by WIC. Please indicate the appropriateness of the following foods to accompany the prescribed formula. WIC Foods That May Be Provided (12 Months and Older, Adults) Check this box to give authority to the WIC health professional (RD/LD, RN or DTR) to prescribe the foods listed below based upon the complete nutritional assessment. Milk Substitutions: (Children Age 2 Years and Older & Adults) Indicate which foods are to be substituted for reduced fat, low fat or skim milk for the following diagnoses: Lactose intolerance, FTT, slow weight gain, low/under weight, or other qualifying conditions. Are there any contraindications or restrictions for any of these foods? Yes, specify: *Only for patients receiving a prescribed formula who require additional calories Whole milk Lactaid whole milk Cheese Milk Beans, dried peas and legumes Juice Peanut butter (Children Age 1 Years and Older & Adults) Breakfast cereal Whole grains Indicate which foods are to be substituted for whole, reduced fat, low fat Eggs (bread, brown rice, oatmeal, corn/whole wheat tortillas) or skim milk for the following diagnoses: milk allergy, severe lactose Fruits Fish (women only, as applicable) maldigestion, vegetarian/vegan diet or other qualifying conditions. Vegetables *Patient does not need to be on a prescribed formula to receive these foods. Do not provide any of the above WIC foods Soy Milk (child) Tofu (child) >4lbs Tofu (women) Health Care Provider s Name (please print) Health Care Provider s Signature Phone Date (Rev. 10/1/12) PPL 180 This institution is an equal opportunity provider. ODH

8 Common ICD-9 Codes This listing is a sample of common ICD-9 codes which support the issuance of a specialty formula for Ohio WIC participants and is not meant to be all inclusive. Infants and Children Acute Gastritis Allergic Gastroenteritis And Colitis Allergy to Milk Products V15.02 Anemia Anaphylactic Shock Due To Milk Products Celiac Disease Cleft Palate, Cleft Lip , Congenital Heart Disease Cystic Fibrosis Dermatitis Due To Food Taken Internally Developmental Sensory/Motor Delays Diabetes 250 Disorders Relating To Extreme Immaturity Of Infant , , , , (<500g, g, g, g, g) Failure to Thrive Fetal Alcohol Syndrome Gastro Esophageal Reflux Disease (GERD) Severe Lactose Intolerance Immunodeficiency Short Stature Underweight Unspecified Intestinal Malabsorption Breastfeeding, Pregnant, Postpartum Women Allergy to Milk Products V15.02 Anemia Cesarean Delivery Gestational Diabetes Hyperemesis Gravidarum Low Maternal Weight Gain Maternal Weight Loss During Pregnancy Severe Lactose Intolerance Multifetal Gestation 651 Examples of non-qualifying conditions that do NOT support WIC issuance of specialty formulas: Non-specific symptoms or diagnosis (e.g., formula/food intolerance, spitting up, colic, constipation, fussiness, and gas). Solely for the purpose of enhancing nutrient intake or managing body weight without an underlying qualifying medical condition (e.g., poor appetite, picky eater). Food or formula intolerance that can be successfully managed with the use of WIC foods or contract formulas. Parental/patient preference or food dislikes. Rev PPL 176; Reissued PPL 178

9 Milk-based Iron-Fortified Infant Formula: Product Name Similac Advance with Early Shield Infant Formulas Indications for Use Standard, milk-based, intact protein formula for the healthy full term infant. Powder 12.4 oz Concentrate 13 oz Ready to Feed* 8oz 32 oz (1 QT) Soy-based Iron-Fortified Infant Formula: Product Name Similac Soy Isomil Indications for Use Standard, soy-based, intact protein formula for the healthy full term infant. Powder 12.4 oz Concentrate 13 oz Ready to Feed* 8oz 32 oz (1 QT) Milk-based, Low-Lactose Infant Formula: Product Name Similac Sensitive Indications for Use Standard, milk-based, low-lactose, intact protein formula for infants with symptomss of lactose intolerance. Powder 12.6 oz Concentrate 13 oz Ready to Feed* 8oz 32 oz (1 QT) Milk-based, Added Rice Starch Infant Formula: Product Name Indications for Use Similac for Spit-Up Standard, milk-based, intact protein formula with added rice starch for infants with GERD, symptoms of GERD, or other feeding disorders. Powder 12.3 oz Concentrate Ready to Feed* 32 oz (1 QT) Milk-based, Premature Infant Formulas: Product Name Indications for Use Powder Concentrate Ready to Feed* Enfamil EnfaCare Standard, milk-based, intact protein formula for the premature infant (<37 weeks gestation) oz (1 QT) Similac Expert Care NeoSure Standard, milk-based, intact protein formula for the premature infant (<37 weeks gestation) oz 32 oz (1 QT) *According to WIC Federal Regulations, Ready to Feed infant formula may only be provided to infants who meet certainn conditions as determined by a WIC health professional. This institutionn is an equal opportunity provider. Effective

10 Milk-based, Modified Vitamin and Mineral Content Infant Formula: * Similac PM 60/40 Milk-based, intact protein formula with reduced levels of several vitamins, minerals and electrolytes for the infant with hypocalcaemia or whose renal, digestive, or cardiovascular functions require reduced minerals oz Milk-based, High MCT Oil Infant Formula: * Enfamil Enfaport Milk-based, intact protein formula for infants with fat malabsorption such as chylothorax or Long-chain 3 hydroxyacyl CoA Dehydrogense deficiency (LCHAD). Hypoallergenic Infant Formulas: * Enfamil Nutramigen with Enflora LGG Extensively Hydrolyzed Protein, Lactose-Free formula for infants with intact cow s milk or soy 12.6 oz protein sensitivity. Enfamil Nutramigen Extensively Hydrolyzed Protein, Lactose-Free formula for infants with intact cow s milk or soy 13 oz 32 oz (1 QT) protein sensitivity. Enfamil Pregestimil Extensively Hydrolyzed Protein, Lactose-Free formula for infants with intact cow s milk or soy protein sensitivity. Contains 50% fat as MCT 16 oz for infants with fat malabsorption. Similac Expert Care Alimentum Extensively Hydrolyzed Protein, Lactose-Free formula for infants with intact cow s milk or soy protein sensitivity. Contains 33% fat as MCT for infants with fat malabsorption. 16 oz 32 oz (1 QT) *According to WIC Federal Regulations, Ready to Feed infant formula may only be provided to infants who meet certain conditions as determined by a WIC health professional. This institution is an equal opportunity provider. Effective

11 Hypoallergenic Infant Formulas continued: EleCare for Infants Neocate Infant with DHA & ARA Nutramigen AA Amino acid based formula for infants with sensitivity to extensively hydrolyzed protein, gastrointestinal impairment, or severe food allergies. Amino acid based formula for infants with sensitivity to extensively hydrolyzed protein, gastrointestinal impairment, or severe food allergies. Amino acid based formula for infants with sensitivity to extensively hydrolyzed protein, gastrointestinal impairment, or severe food allergies oz 14 oz 14.1 oz Hypoallergenic Medical Food: * Neocate Nutra Amino acid based semi-solid medical food for infants >6 months with intact protein intolerance. For oral use only. Not intended for use in a bottle or tube feed. Not suitable as a sole source of nutrition. 14 oz Child Formulas Milk-Based, Blenderized Food Pediatric Formulas: Compleat Pediatric For children with an intolerance to standard pediatric formulas requiring tube feeding. Made 8.45 oz from real blenderized foods. Compleat Pediatric Reduced Calorie For children with an intolerance to standard pediatric formulas requiring tube feeding. Reduced calorie for decreased energy needs oz *According to WIC Federal Regulations, Ready to Feed infant formula may only be provided to infants who meet certain conditions as determined by a WIC health professional. This institution is an equal opportunity provider. Effective

12 Milk-Based, Pediatric Formulas: Boost Kid Essentials 1.0 Cal (retail) Standard, intact protein, lactose-free, gluten-free formula for children requiring oral 8.25 supplementation. Boost Kid Essentials 1.0 Cal (pharmacy only) Standard, intact protein, lactose-free, gluten-free formula for children requiring tube feeding, full diet or oral supplementation. PediaSure Standard, intact protein, lactose-free, gluten-free formula for children requiring tube feeding, full diet or oral supplementation. PediaSure with Fiber Standard, intact protein, lactose-free, gluten-free formula for children requiring tube feeding, full diet or oral supplementation. PediaSure Enteral Standard, intact protein, lactose-free, gluten-free formula for children requiring tube feeding, full diet or oral supplementation. PediaSure Enteral with Fiber Standard, intact protein, lactose-free, gluten-free formula for children requiring tube feeding, full diet or oral supplementation. Nutren Junior Standard, intact protein, lactose-free, gluten-free formula for children requiring tube feeding, full 8.45 oz diet or oral supplementation. Nutren Junior with Fiber Standard, intact protein, lactose-free, gluten-free formula for children requiring tube feeding, full 8.45 oz diet or oral supplementation. Milk-Based, High Calorie Pediatric Formulas: Boost Kid Essentials 1.5 Cal Nutritionally complete, intact protein, lactosefree, gluten free formula for children requiring higher calorie needs and tube feeding, full diet or oral supplementation. *According to WIC Federal Regulations, Ready to Feed infant formula may only be provided to infants who meet certain conditions as determined by a WIC health professional. This institution is an equal opportunity provider. Effective

13 Milk-Based, High Calorie Pediatric Formulas continued: Boost Kid Essentials 1.5 Cal with Fiber Nutritionally complete, intact protein, lactosefree, gluten free formula with fiber for children requiring higher calorie needs and tube feeding, full diet or oral supplementation. PediaSure 1.5 Cal Nutritionally complete, intact protein, lactosefree, gluten-free formula for children requiring higher calorie needs and tube feeding, full diet or oral supplementation. PediaSure 1.5 Cal with Fiber Nutritionally complete, intact protein, lactosefree, gluten-free formula for children requiring higher calorie needs and tube feeding, full diet or oral supplementation. Soy-Based Pediatric Formula: This product is not to be used as a substitute for soy milk unless medically warranted. Bright Beginnings Soy Pediatric Drink Nutritionally complete, intact protein, lactosefree, gluten-free formula for children requiring tube feeding, full diet or oral supplementation. Peptide-Based Pediatric Formulas: PediaSure Peptide Nutritionally complete, lactose-free formula for children with gastrointestinal impairment and/or malabsorption requiring tube feeding, full diet, or oral supplementation. Peptamen Junior Nutritionally complete, lactose-free formula for children with gastrointestinal impairment and/or malabsorption requiring tube feeding, full diet, 8.45 oz or oral supplementation. Peptamen Junior with Fiber Nutritionally complete, lactose-free formula for children with gastrointestinal impairment and/or malabsorption requiring tube feeding, full diet, 8.45 oz or oral supplementation. *According to WIC Federal Regulations, Ready to Feed infant formula may only be provided to infants who meet certain conditions as determined by a WIC health professional. This institution is an equal opportunity provider. Effective

14 Peptide-Based Pediatric Formulas Continued: Peptamen Junior with Prebio 1 Nutritionally complete, lactose-free formula for children with gastrointestinal impairment and/or malabsorption requiring tube feeding, full diet, or oral supplementation oz Peptide-Based, High Calorie Pediatric Formulas: PediaSure Peptide 1.5 Cal Nutritionally complete, lactose-free formula for children with higher calorie needs and gastrointestinal impairment and/or malabsorption requiring tube feeding, full diet, or oral supplementation. Peptamen Junior 1.5 Cal Nutritionally complete, lactose-free formula for children with higher calorie needs and gastrointestinal impairment and/or 8.45 oz malabsorption requiring tube feeding, full diet, or oral supplementation. Hypoallergenic, High MCT Oil Pediatric Formulas: EleCare Junior Unflavored Amino acid based (100%), nutritionally complete formula for children with severe food allergies, gastrointestinal impairment, or 14.1 oz malabsorption who are allergic to peptide-based (extensively hydrolyzed) formulas. EleCare Junior Vanilla Amino acid based (100%), nutritionally complete formula for children with severe food allergies, gastrointestinal impairment, or 14.1 oz malabsorption who are allergic to peptide-based (extensively hydrolyzed) formulas. E028 Splash Amino acid based (100%), nutritionally complete formula for children with severe food allergies, gastrointestinal impairment, or malabsorption who are allergic to peptide-based (extensively hydrolyzed) formulas. *According to WIC Federal Regulations, Ready to Feed infant formula may only be provided to infants who meet certain conditions as determined by a WIC health professional. This institution is an equal opportunity provider. Effective

15 Hypoallergenic, High MCT Oil Pediatric Formulas Continued: Neocate Junior Amino acid based (100%), nutritionally complete formula for children with severe food allergies, gastrointestinal impairment, or malabsorption who are allergic to peptide-based (extensively hydrolyzed) formulas. Neocate Junior with Prebiotics Amino acid based (100%), nutritionally complete formula for children with severe food allergies, gastrointestinal impairment, or malabsorption who are allergic to peptide-based (extensively hydrolyzed) formulas. Vivonex Pediatric Amino acid based (100%), nutritionally complete formula for children with severe food allergies, gastrointestinal impairment, or malabsorption who are allergic to peptide-based (extensively hydrolyzed) formulas. 14 oz 14 oz 1.72 oz Hypoallergenic Medical Food: Neocate Nutra Amino acid based semi-solid medical food for children with intact protein intolerance. For oral use only. Not intended for use in a bottle or tube feed. Not suitable as a sole source of nutrition 14.1 oz Ketogenic Formula: KetoCal 4:1 For children with intractable epilepsy, pyruvate dehydrogenase deficiency (PDH) or glucose transporter type-1 deficiency. 11 oz 8oz *According to WIC Federal Regulations, Ready to Feed infant formula may only be provided to infants who meet certain conditions as determined by a WIC health professional. This institution is an equal opportunity provider. Effective

16 Child and Adult Formulas Clear Liquid Formula: Resource Boost Breeze Fruit flavored, low fat, lactose and gluten-free formula for children or women with fat malabsorption or intolerance of milkshake-like supplemental beverages. Not nutritionally complete. Milk-based, High MCT Oil Formulas: Monogen Lactose-free, gluten-free formula for children and women with fat malabsorption. Contains 14.3 oz 90% fat as MCT oil. Portagen Lactose-free, gluten-free formula for children and women with fat malabsorption. Contains 87% fat as MCT oil. 16 oz Caloric Additive: Super Soluble Duocal Energy enhancer; provides 42 calories per tablespoon from carbohydrates and fats only, indicated for children and women with disorders of protein and amino acid metabolism, protein restricted diets, or high energy diets (i.e., FTT). 14 oz Adult Formulas Milk-based Adult Formulas: Boost Nutritionally complete, lactose and gluten-free formula for women with increased calorie needs. Ensure Nutritionally complete, lactose and gluten-free formula for women with increased calorie needs. *According to WIC Federal Regulations, Ready to Feed infant formula may only be provided to infants who meet certain conditions as determined by a WIC health professional. This institution is an equal opportunity provider. Effective

17 New Neocate Packaging Great New Look, Same Great Products! August 2012 Dear WIC Official, Nutricia North America will soon have a new and improved packaging look for Neocate Junior (similar to our new Prebiotics Vanilla) and Neocate Nutra. This new packaging look will be seen in the market starting in September. Neocate Junior varieties will have no change in can size, price, codes or ingredients. Neocate Junior remains the same great product with the same great benefits! Benefits of new packaging: Clearer flavor communication and differentiation Simpler easy-to-read preparation Neocate Junior: Big and bold cup icon indicates for children 1 year and older Neocate Nutra will have a big and bold bowl and spoon icon to indicates it is a food item for children 6 months and older. Neocate Nutra will have no change in can size, however the codes and case pack will be changing. Neocate Nutra case size will change from a 3 pack to a 4 pack. Please inform your colleagues and WIC clinics of this change when ordering Neocate Nutra (see new Neocate Nutra codes below). Neocate Nutra OLD NEW Pack Size: 400 grams x 3 cans 400 grams x 4 cans Nutricia Product Code: Nutricia Unit Code: Nutricia Case Code: NDC code: Neocate Nutra Neocate Nutra Ingredient Change The corn starch will be replaced with a pregelatinized rice starch which is highly refined to remove any rice protein leaving purely the starch component. The change to hypoallergenic rice starch was necessitated by a limited supply of hypoallergenic corn starch. This change will maintain the highest quality Neocate Nutra for your patients. Neocate Junior Unflavored (Unflavored) Neocate Junior with Prebiotics To help you identify the new packaging upon its arrival, please see the new look (to the right). Clinically proven Neocate the trusted family of amino acid-based nutrition shown to be effective in the dietary management of food allergy-associated conditions such as CMA, MFPI, EoE, SBS, GERD and other GI conditions. Neocate Junior Chocolate If you or caregivers have any questions, please call our Customer Service Department toll-free at NEOCATE, Monday through Friday, 8:30 am 7:00 pm EST, or visit Neocate Junior Tropical Sincerely, Neocate s Specialized Pediatric Team NEOCATE ( )