| Compleat 1.06 |
Adult, Oral
|
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)
|
| Compleat ADULT 1.5 |
Adult, Oral
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Compleat Junior |
Pediatric
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Compleat Junior 1.5 |
Pediatric, Oral
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Compleat Organic Blend |
Adult, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Compleat Pediatric Organic Blend |
Pediatric, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Complete Amino Acid Mix |
Infant, Pediatric, Adult, Modules, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Duocal Powder by the can |
Infant, Pediatric, Adult, Modules, Oral
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| EnfaCare A+ Powder |
Infant, Oral
|
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)
|
| Enfamil A+ 385 mL Liquid concentrate |
Infant, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|