The formula4success™ service offers personalized support to individuals with reimbursement questions regarding Nestlé enteral nutrition products.

Payer Resources

Benefit and Qualifications

Plans may consider payment for tube feeding and oral supplements when medically necessary. Check with the payer’s benefit manager for specific coverage and payment information. Certain states require coverage for specific conditions or types of products.

For further information contact your benefit manager or call formula4success™ at 1-844-283-0365

Government Programs

Benefit and Qualifications

WIC provides Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. WIC provides iron-fortified infant formula for infants who are not fully breastfed. Specialty formulas and medical foods may be provided when prescribed by a physician for a specified medical condition.

View Frequently Asked WIC Questions

Further Information

For a list of WIC Eligible Medical Foods go to the USDA WIC Works Database and use the “Selected Search by Category” feature to find a specific product:

Search for WIC Eligible Formulas

*WIC is a registered service mark of the U.S. Department of Agriculture for USDA’s Special Supplemental Nutrition Program for Women, Infants and Children

Benefit and Qualifications

The Children’s Health Insurance Program (CHIP) provides comprehensive benefits to children. Since states have flexibility to design their own program within Federal guidelines, benefits vary by state and by the type of CHIP program.

Medicaid Expansion CHIP programs provide the standard Medicaid benefit package, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which includes all medically necessary services like mental health and dental services.

Learn More About CHIP Benefits

Benefit and Qualifications

Enteral nutrition policies regarding tube feeding and oral supplements for adults and children vary from state to state. When a Managed Medicaid program is being utilized, the payer responsible for the program may provide additional benefits. When there is a benefit policy in place, most policies require that there is a documented medical need for the therapy.

Further Information

For further information on your state specific enteral nutrition policy go to medicaid.gov or call formula4success™ at 1-844-283-0365. For information on a Managed Medicaid program, contact the commercial payer’s benefit manager for specific coverage and payment information.

Search for State Specific Benefits

Benefit and Qualifications

Medicare generally covers enteral tube feeding when provided in the following patient care settings:

  • Patient’s Home
  • Custodial Care Facility
  • Intermediate Care Facility
  • Skilled Nursing Facility (unless patient is covered under a Part A stay)
  • Adult Foster Care or Group Home
  • Assisted Living Facility

Medicare does not cover:

  • Temporary impairment
  • Diagnosis that does not address the inability to consume and digest foods through the normal route
  • Oral nutrition supplements
  • Enteral products furnished during a Part A stay
  • Food thickeners, self-blenderized formula

The following criteria must be met to qualify for standard tube feeding reimbursement:

  • Diagnosis reflecting a functional impairment
  • Tube feeding is required to “provide sufficient nutrients to maintain weight and strength commensurate with the patient’s overall health status”
  • Impairment of long and indefinite duration
  • Adequate nutrition must not be possible by dietary adjustment and/or oral supplements
Medicare Enteral Nutrition Policy Information

Benefit and Qualifications

TRICARE is the health care program of the United States Department of Defense Military Health System. Tricare provides civilian health benefits for military personnel, military retirees, and their dependents, including some members of the Reserve Component.

Learn More About Tricare Nutrition Benefits

formula4success™ and its agents and contractors do not guarantee coverage by any insurance plan providers and will not reimburse any claims denied by third party payers.

Enroll Now!

Our dedicated specialists are available to help patients or their caregivers save time and make the process easier for understanding and accessing potential coverage for Nestlé enteral nutrition products.
1-844-283-0365

Call formula4success to begin enrollment by phone

Fill out the Enrollment Form and FAX to formula4success at 1-855-727-2513 or scan/email to [email protected]