| Similac Neosure Oral Powder |
Infant
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| SolCarb by the can |
Modules
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Suplena Oral Liquid |
Pediatric, Adult
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Thicken Up Clear - powder |
Pediatric, Adult, Modules, Oral
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Special Authorization (RD)
|
Regular Benefit - needs Prescription
|
Special Authorization (RD)
|
Limited Use (NIHB)
|
| Thicken Up Oral Powder |
Pediatric, Adult, Oral
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Special Authorization (RD)
|
Regular Benefit - needs Prescription
|
Special Authorization (RD)
|
Limited Use (NIHB)
|
| Tolerex Oral Powder |
Pediatric, Adult
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Twocal HN Oral Liquid |
Adult
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Vital Peptide 1.5 Cal Oral Liquid |
Adult
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Vivonex Plus |
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Vivonex T.E.N. Oral Powder |
Adult
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Not Covered
|
Special Authorization (RD)
|
Limited Use (NIHB)
|