Therapeutic Formula for WIC-Eligible Patients

If one of WIC’s standard contract formulas is inappropriate for your patient, there may be a medical condition warranting a therapeutic formula.

Prescribing Therapeutic Formula

WIC is a nutrition program that is NOT funded to give formulas for medical conditions. Since WIC is not a medical program, physicians should follow the procedures of the health plan below if they prescribe a therapeutic or special formula.

Private or Military Insurance:

  • The physician must submit the required paperwork requesting the formula to the health plan.
  • If the health plan denies the formula, the patient should take the complete *prescription (Rx) to their WIC site for Nutritionist evaluation. 

* Prescription contains patient name, birth date, name of formula, diagnosis, amount needed per day, duration, and signature of healthcare provider.

Private or Military Medi-Cal Managed Care Plan (IEHP, Molina, or SCAN):

  • The physician must submit a request for prior authorization to the health plan. Medi-Cal Managed Care Plans are required to provide medically necessary formulas.  For specific MMC policy information on therapeutic formula provision, go to the MMCD Policy Letter.
  • The physician needs to provide a complete prescription (Rx) for formula and tell the patient to take it to a pharmacy that contracts with the specific MMC plan.
  • The patient should call membership services for the plan if they need help. The phone number is on the back of their benefits card.
  • If the patient is experiencing difficulty obtaining plan coverage, they should call the Medi-Cal Managed Care Ombudsman at 1-888-452-8609 to resolve any problems. 

Full Scope Medi-Cal (known as Regular Medi-Cal):

  1. The physician should provide the patient with a complete prescription (Rx) written on office letterhead or script pad.
  2. The physician should tell the patient to take the prescription (Rx) to their pharmacy for filling.
  3. If the therapeutic formula is denied, the patient should return to their WIC site with verbal or written denial from the pharmacist stating the reason for denial. Verbal denial will be verified by a WIC Nutritionist by calling the pharmacy. 
  4. Once denial is verified, WIC will issue formula.
  5. The WIC Nutritionist will instruct the participant to take a complete prescription (Rx) to a different pharmacy if the initial pharmacy is unwilling to investigate and resolve the reason for the denial.

No Insurance:

  • Refer the patient to CHDP Gateway Program at 1-800-722-3777.

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WIC Locations

Barstow WIC
301 East Mt. View Ave., Suite A
Barstow, CA 92311

Colton WIC
290 East “O” St.
Colton, CA 92324

Fontana WIC
9161 Sierra Ave., Suite104
Fontana, CA 92335

Fort Irwin WIC
Inner Loop and Goldstone, Room 9
Fort Irwin, CA 92310

Hesperia WIC
14135 Main Street, Suite 250
Hesperia, CA 92345

Ontario WIC
150 East Holt Blvd.
Ontario, CA 91761

Rancho WIC
9507 Arrow Rte, Bldg7, Suite A
Rancho Cucamonga, CA 91730

Redlands WIC
800 East Lugonia Ave., Suite K
Redlands, CA 92374

Foothill WIC
850 East Foothill Blvd. 
Rialto, CA 92376

Highland WIC 
1535 East Highland Ave.
San Bernardino, CA 92404

Mill WIC
606 East Mill Street
San Bernardino, CA 92408

Yucca Valley WIC
Dept of Public Social Services
56357 Pima Trail
Yucca Valley, CA 92284

San Bernardino WIC
2035 North D Street
San Bernardino, CA 92405

Twentynine Palms WIC
6527 Desert Queen Ave.
Twentynine Palms, CA 92277

Victorville WIC
15247 11th Street, Suite 700
Victorville, CA 92395