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.
As part of the patient’s treatment plan, therapeutic formulas should be covered by the health plan when the clinician provides adequate medical justification.
Choose the formula that is right for your patient!
Should your patient be denied coverage by Medi-Cal or other health insurance, WIC may provide the therapeutic formula. WIC will require a letter of denial from the health plan and Medi-Cal.
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 Private or Military Insurance
- Medi-Cal Managed Care Plan Medi-Cal Managed Care Plan
- Full Scope Medi-Cal Full Scope Medi-Cal
- No Insurance No Insurance
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):
- The physician should provide the patient with a complete prescription (Rx) written on office letterhead or script pad.
- The physician should tell the patient to take the prescription (Rx) to their pharmacy for filling.
- 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.
- Once denial is verified, WIC will issue formula.
- 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