Pediatric and Primary Care Providers: New Process for Prescribing Specialized Formulas

REQUIREMENTS: By July 1, 2026, billing team must: (1) Stop directing MO HealthNet-enrolled patients to WIC clinics for specialized infant formulas; instead route all specialized formula prescriptions to MO HealthNet-enrolled DME providers (same process as enteral nutrition supplies); (2) Monitor MHD DME website Resources section for comprehensive list of DME companies approved to dispense specialized formulas as it becomes available; (3) Update internal routing protocols and provider education materials to reflect new billing pathway; (4) For claims processing, ensure specialized formula claims are billed to MO HealthNet primary payer, not WIC, when patient has active MO HealthNet coverage; (5) Providers must continue completing WIC-27 Medical Documentation Form when requesting formula approval during transition period; (6) Contact Provider Communications at (573) 751-2896 or toll-free (833) 222-7916 for DME billing codes, procedure codes, or prior authorization requirements. Failure to route claims correctly will delay reimbursement and may result in claim denials. WIC will only pay as secondary/safety net when MO HealthNet coverage is not active or formula is not covered by insurance.