MO HealthNet has made a change to its special formula billing procedures to address shortages of durable medical equipment (DME) providers who supply formulas. Effective September 15, 2026, health care providers (HCPs) will send formula requests to either pharmacy providers or DME providers. WIC participants who are already set up with a DME provider do not need to switch providers. DME companies can continue to provide the formula, but they must follow pharmacy billing procedures outlined in the Billing Guidance Update for Specialized Infant Formulas bulletin posted by MO HealthNet.
Pharmacies may not mail formulas directly to a participant’s home. If using a pharmacy provider, HCPs will work with the participant to identify one that is within a reasonable travel distance. MO HealthNet-approved pharmacies can be found using the MO HealthNet Fee-For-Service Provider Search tool.
WIC local agency staff will continue to refer participants who need a special formula to their HCP. If a formula request is pending approval, HCPs may send a medical documentation form (WIC-27) to the participant’s WIC local agency. The WIC local agency will issue a month of formula and follow up with the participant before issuing additional months’ benefits. If the insurance denies coverage, HCPs should send the official denial notice to the WIC local agency. WIC will continue to be the payer of last resort for participants whose insurance denies coverage of special formula if the participant has a qualifying medical condition. If a DME or pharmacy determines it cannot fill the formula request, the HCP should send the request to another approved provider until one is identified. For assistance with finding a pharmacy or DME provider, contact the participant’s insurance company.
WIC will continue to be the primary payer for the following formulas:
- Similac Advance.
- Similac Sensitive.
- Similac Gentle Comfort.
- Similac Soy Isomil
WIC also provides Enfamil A.R. with a medical documentation form (WIC-27).
For questions regarding the MO HealthNet update, please use the contact information included on the provider bulletin.
For questions regarding WIC’s process for providing formula to infants and children, please email WICinfo@health.mo.gov.
This update is only for MO HealthNet participants. Missouri WIC has not received any information about changes from Tri-Care or private insurance companies.