For Health Care Providers

Clinical Resource Guide Prescription Medical Formula Guidance

Maine WIC Formulary Prescribers

• Frequently Asked Questions About WIC

Clinical Resource Guide

• Overview
• Breastfeeding guidance for clinicians
• Medical Formula and MaineCare Recipients
• Download Clinical Resource Guide (PDF*, 2.2 MB)

Conditions that may require prescription of medical formula

• Preterm and Low Birth Weight Infants
• Gastroesophageal Reflux Disorder
• Use of Soy Formulas
• Use of Hypoallergenic Infant Formulas
• Failure to Thrive, Congenital Heart and Renal Disorders, Malabsorption
• Ready-to-Feed and Pre-Prepared Formulas
• Metabolic Diseases

Maine WIC Formulary

• Standard Cow's Milk and Soy Formulas (*PDF) (Contract and Non-Contract)
• Preterm and Low Birth Weight Formulas (*PDF)
• Gastroesophageal Reflux Formulas (*PDF)
• Soy Formulas (*PDF)
• Hypoallergenic Formulas (*PDF)
• Formula for Failure to Thrive, Heart and Renal Disorders, Malabsorption (*PDF)
• WIC and Ready-to-Feed Formulas (*PDF)
• Metabolic Formulas (*PDF)

For Prescribers

• Medical Documentation and Prior Authorization
• Maximum Formula Issuance