West Virginia WIC Policy & Procedure 4.02 Effective Date: 03/30/2026

4.02 Standard Contract Infant Formula

POLICY: The West Virginia WIC Program has a contract with an infant formula company to be reimbursed for the issuance of standard milk-based formula, standard soy-based formula, and standard milk-based formula without lactose through an infant feeding rebate system. All other standard infant formulas exempt infant formulas, WIC-eligible nutritionals and supplemental foods are considered non-contract. Note: Formula is considered out-of-date on the first day of the month labeled as the expiration date. PROCEDURE: A. Standard Contract Infant Formula 1. Only a Competent Professional Authority (CPA) is authorized to prescribe supplemental foods in quantities that meet the maximum monthly allowance (MMA) and are appropriate for the participant, taking into consideration the participant’s age and nutritional needs. 2. Standard contract infant formulas that are provided through the West Virginia WIC Program are: a. Similac Advance OptiGrow b. Similac Soy Isomil c. Similac Sensitive for Fussiness & Gas d. Similac Gentle Comfort Note: Similac Pro Advance, Similac Pro Sensitive, Similac 360 Total Care and Similac Pro Total Comfort cannot be issued to West Virginia WIC Program participants. 3. CPAs must issue all WIC formulas in concentrated liquid or powder physical forms. a. Ready-to-feed (RTF) formulas can be authorized when the Nutritionist (CPA) determines necessary (see Policy 4.03 Ready-to-Feed). 4. The CPA can issue standard contract infant formula to certified infants without the use of the Prescription Formula Form (WIC-53). B. Formula Issuance 1. Standard contract infant formula will be issued and will continue through the month of the infant’s first birthday. 2. The parent/guardian or caretaker can request a formula change to a different standard contract infant formula.

West Virginia WIC Policy & Procedure 4.02 Effective Date: 03/30/2026 4.02 Standard Contract Infant Formula

3. When a parent/guardian requests an exempt infant formula or WIC-eligible nutritional, a Formula Prescription Form (WIC-53) must be completed by a healthcare professional licensed to write medical prescriptions under State Law (see Policy 4.09 Food Package III, Women, Infants and Children with Qualifying Medical Conditions). C. Standard Non-Contract Infant Formula 1. All standard milk-based formula, standard soy-based formula and standard milk-based formula without lactose that are not specified through an infant feeding rebate system are considered non-contract formula and cannot be issued to West Virginia WIC Program participants. REFERENCES: 1. WIC Regulations 7 CFR 246.10 Supplemental Foods 2. WIC Regulations 246.16a Infant Formula and Authorized Foods Cost Containment 3. USDA Nutrition Services Standards, Chapter 13, Food Package Prescriptions 4. USDA Special Supplemental Nutrition Program for Women, Infants and Children, Food Package Policy and Guidance, Chapter 2, Food Package Design 5. USDA Special Supplemental Nutrition Program for Women, Infants and Children, Food Package Policy and Guidance Chapter 3, Determining Eligibility of WIC Foods 6. USDA Special Supplemental Nutrition Program for Women, Infants and Children, Food Package Policy and Guidance Chapter 6, WIC Formula