For Health Care Providers

Need help? If you have difficulty understanding English or have a disability, free language assistance or other aids and services are available upon request. Please contact your Local WIC Clinic agency for more information.

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ATTENTION

All MaineCare Prior Authorizations should be forwarded to WIC.Maine@maine.gov Due to the COVID-19 pandemic, we will have very limited access to our fax machine. Thank you for understanding.

COVID-19 Announcement (PDF)

WIC provides breastfeeding counseling, support and education to all pregnant and breastfeeding women. WIC also provides loaner breast pumps to breastfeeding mothers.

Infants who are not exclusively breastfed can be provided formula, up to the WIC Maximum Monthly Amount (Excel). If a non-standard formula is medically indicated, please complete the Prior Authorization form below.

Medical Documentation and Prior Authorization Form

Baby getting a medical exam

This form is required before non-standard/medical formula can be provided to WIC participants. Health care providers, please follow these steps:

  • Download the form in Word or PDF format
  • Fill out form
  • Email your local WIC office or to the State WIC Agency at wic.maine@maine.gov

Former Standing Order Forms

The standard Abbott Similac contract formulas that were previously 19kcals/oz (Sensitive, Total Comfort, and Spit-Up) have been reformulated to 20kcals/oz and no longer require our Standing Order Form.

Maine CDC WIC Nutrition Program Formulary

The Maine CDC WIC Formulary includes standard and medical formulas. All prescription formula request for items not included on our Formulary are evaluated biannually through an internal submission review process. These reviews take place in June and January. If your organization has a request for an exempt formula or qualifying nutritional, please forward the formula information and include the UPC and formula product label (manufacturer product website page, if possible) to wic.maine@maine.gov. Only contract brand standard formulas can be provided.

Provision of Ready To Feed (RTF) formulas:

WIC staff may provide ready to feed (RTF) infant formulas for a WIC participant only when assessment determines that at least one of the following conditions exists:

  • The participant's household has an unsanitary or restricted water supply or poor refrigeration
  • The person caring for the participant may have difficulty in correctly diluting concentrated or powdered formulas
  • The formula is only available in ready-to-feed form.

Participants with a prescription for a medically necessary formula (non-standard formula, exempt formula, WIC-eligible nutritional) may be provided RTF formula for the following additional reasons:

  • The ready to feed form better accommodates the participant’s condition
  • The ready to feed form improves the participant’s compliance in consuming the prescribed WIC formula

For information on RTF forms of specific formulas, consult the appropriate section of the WIC formulary.