special formula, NJ

amother

Wed, Jan 03 2024, 11:51 am

Hi. I don't have Jersey Care and won't be approved for Wic. What is the process of getting formula covered by insurance? Is that a possibility? Family history of allergies, 2/3 kids needed hypoallergenic formula, 1 was fully nursed but ended up having lots of allergies so its miraculous that we never needed formula.

Is this something my insurance will fully cover or is it something I will need to pay towards till I hit my deductible?

amother

Jetblack

Wed, Jan 03 2024, 12:53 pm

First step would be getting your doc to write RX with total daily calories and mode of administration (oral vs tube) to a pharmacy like Enexia. Enexia is experienced with Looking into coverage and benefits and if it’s a Benefit, I’m trying to get the auth. Make sure your doc also puts 5 refills on the rx

It‘a difficult to get private insurance to pay for oral formula. Oftentimes it’s just not a covered benefit so I’d lower expectations and start researching the cheapest place to order from (Amazon etc)

Ema of 5

Wed, Jan 03 2024, 12:55 pm

When my baby was switched to hypoallergenic formula due to allergy concerns, the GI wrote a prescription and sent it to Enexia, the pharmacy someone else mentioned. I had no problem getting it covered by my insurance. What they DIDNT cover was the gelmix thickener that he needed. Now he is getting katefarms shakes and those are covered too.

amother

Jetblack

Wed, Jan 03 2024, 1:08 pm

Ema of 5 wrote:

Ooc What insurance do you have? Some, like Cigna, don’t typically cover insurance at all even through a tube, so there’s a broad range of coverage (Thickeners are never covered)

amother

Wed, Jan 03 2024, 1:12 pm

Thank you. I will start looking into it. My allergist didn't want to discuss it till I actually give birth but I am having axiety about pumping and work and need to know we have a backup option. One of my kids never nursed successfully and was on hypoallergenic formula by 2.5 weeks after trialing other options.

GLUE

Wed, Jan 03 2024, 1:26 pm

Speak to your pediatrician, it is not uncommon for people to talk to there pediatrician about their unborn child.
If you know you have or might have a problem after the baby is born your pediatrician can help you before the child is born.

amother

Jetblack

Wed, Jan 03 2024, 1:27 pm

GLUE wrote:

But they can’t send a prescription for an unborn baby

amother

Wed, Jan 03 2024, 1:39 pm

I would buy a can to have to start with. I will discuss it with the pediatrician but its not the same practice I used for my other kids.

Ema of 5

Wed, Jan 03 2024, 2:00 pm

amother Jetblack wrote:

Ooc What insurance do you have? Some, like Cigna, don’t typically cover insurance at all even through a tube, so there’s a broad range of coverage (Thickeners are never covered)

Aetna

amother

Wed, Jan 03 2024, 3:27 pm

Ema of 5 wrote:

Aetna

That's what I also have. Thank you for the information. My other kids where a different insurance and state and 2 where eligble for Wic which ended up cover part of it. I know from my friends in NJ that insurance makes you try Wic first so was wondering what happens.

Ema of 5

Wed, Jan 03 2024, 3:37 pm

amother OP wrote:

I never had wic for any of my kids, so I can’t help you out there.

GLUE

Wed, Jan 03 2024, 6:10 pm

amother OP wrote:

You get a Dr. note saying what formula you need.
Wic will only pay for formula that they have a contract for. So it is best to find out what brands and types of formula they will pay for before you get the Dr. note.
Call them up to find out.

amother

Tulip

Wed, Jan 03 2024, 6:16 pm

Most pediatricians get samples from formula companies. I used Elecare as a supplement to nursing so I didn't need as much as exclusive formula feeding but my pediatrician was extremely generous with the amount of cans they gave me.

amother

Thu, Jan 04 2024, 3:21 pm

amother Tulip wrote:

Was your baby ok going back and forth between Elacare and nursing? I once tasted Elacare years ago bymistake and just the thought of it had me shuddering for a few years. My oldest was very picky with formulas but also switched over the latest. Kid would only drink ready to feed liquid formula, nothing powder based so #2 we got used to room temp water and powder formula right away.

I did end up speaking to our pediatrician about all this today and he said I shouldn't even trial other formulas for this baby, go straight to Nutramigen or Elacare.

amother

Cyclamen

Thu, Jan 04 2024, 3:24 pm

GLUE wrote:

Hypoallergenic formula is different. You need a special form filled out by your doctor, and they'll cover it.

Ema of 5

Thu, Jan 04 2024, 3:40 pm

amother OP wrote:

When my baby was little, I started off supplementing with pumped milk, and then I moved to formula. I was supplementing before 2 months I think. He had no issue going back and forth. He also had no issue when I switched him from materna to hypoallergenic formula.

GLUE

Thu, Jan 04 2024, 3:50 pm

amother Cyclamen wrote:

Hypoallergenic formula is different. You need a special form filled out by your doctor, and they'll cover it.

In my experience they only covered certain brands, then again this was over a decade ago. That baby is now in Mesivta, things could have changed.

amother

Cyclamen

Thu, Jan 04 2024, 3:53 pm

GLUE wrote:

In my experience they only covered certain brands, then again this was over a decade ago. That baby is now in Mesivta, things could have changed.

Yeah so my baby still takes bottles so I'm a little more current Smile

This is special for hypoallergenic formulas. You need the right diagnosis code and everything.

amother

Tulip

Thu, Jan 04 2024, 4:55 pm

GLUE wrote:

In my experience they only covered certain brands, then again this was over a decade ago. That baby is now in Mesivta, things could have changed.

Elecare was covered by WIC with a special form filled out by the doctor.