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Women, Infants & Children (WIC)

WIC Medical Formulas and Nutritionals

WIC provides medical formulas and nutritionals to participants who do not have Medi-Cal coverage or when the prescribed product is not covered by Medi‑Cal. WIC participants must have a qualifying medical condition and complete medical documentation from their Health Care Provider (HCP) to receive the medical formula or nutritional from WIC.

Learn More

  1. WIC Medical Formula Request Process
  2. WIC Approved Formulas and Nutritionals
  3. WIC Qualifying Medical Conditions
  4. WIC Medical Documentation Requirements
  5. WIC Resources for Health Care Providers
  6. Policies and Procedures for WIC Local Agencies
  7. Contact Us
  8. Additional Resources​

WIC Medical Formula Request Process

Please see below on how the WIC medical formula process works:

WIC medical formula process flowchart

WIC Approved Formulas and Nutritionals

The WIC Formulas and Nutritionals List (PDF) is a listing of all the standard formulas, medical formulas, and nutritionals that are approved by WIC. Please contact Formula@cdph.ca.gov to inquire whether a particular product can be approved by WIC and added to the WIC Formulas and Nutritionals List. ​

WIC Qualifying Medical Conditions

WIC qualifying medical diagnoses/conditions for a medical formula or nutritional include, but are not limited to:​

  • Premature birth.
  • Low birth weight.
  • Failure to thrive.
  • Inborn errors of metabolism and metabolic disorders.
  • Gastrointestinal disorders.
  • Malabsorption syndromes.
  • Immune system disorders.
  • Life-threatening disorders.
  • Diseases and medical conditions that impair ingestion, digestion, absorption, or the use of nutrients that could adversely affect the participant's nutrition status.
  • Severe food allergies that require an elemental formula (allergy must be specified).
WIC will not approve a medical formula or nutritional for the following medical diagnoses/conditions:
  • ​Non-specific symptoms or diagnoses (e.g. colic, constipation, diarrhea, spitting up, picky eater, poor appetite, cramps, fussiness, gas, etc.).
  • Condition that is solely for the purpose of enhancing nutrient intake or managing body weight.
  • Non-specific formula intolerance or food intolerance.
  • Preference or food dislikes.

WIC Medical Documentation Requirements

Health Care Providers with prescriptive authority must provide their patients complete medical documentation for any prescribed medical formula or WIC eligible nutritional to be approved by WIC. WIC requires participants to provide updated medical documentation every six months. The following includes, but are not limited to, acceptable forms of WIC medical documentation:

Complete medical documentation must include all the following information to be processed by WIC:
  • ​Participant's first and last name.
  • Qualifying medical condition.
  • Name(s) of the medical formula or nutritional for the stated qualifying diagnosis.
  • ​Formula amount needed per day and duration prescribed in months.
  • WIC authorized food restrictions, if applicable.
  • Signature (or signature stamp) and contact information of the Health Care Provider.
  • Date medical documentation was signed by the Health Care Provider.

WIC Resources for Health Care Providers

Policies and Procedures for WIC Local Agencies

Contact Us

For general inquiries, please contact us at Formula@cdph.ca.gov.

Additional Resources​​

​Formula Product Information

Insurance Resources

​​Mead Johnson
Apply for Medi-Cal
Abbott
Medi-Cal Rx Provider Manual (PDF)
Nutricia
Products eligible for Medi-Cal
(Click on Covered Products Lists on the left; then scroll down to Covered Enteral Nutrition Products)
Nestle/Gerber
​​Find a Medi-Cal Rx Pharmacy


Formula Product Information

Mead Johnson

Abbott

Nutricia

Nestle/Gerber

​Insurance Resources

Medi-Cal

Apply for Medi-Cal

Medi-Cal Rx Provider Manual (PDF)

Products eligible for Medi-Cal
(Click on Covered Products Lists on the left; then scroll down to Covered Enteral Nutrition Products)

Find a Medi-Cal Rx Pharmacy

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