| Enfamil A+ NeuroPro Powder |
Infant, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Enfamil A+ powder |
Infant, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Enfamil Enfalyte |
Infant, Pediatric, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
| Ensure High Protein Oral Liquid |
Pediatric, Adult, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Ensure Oral Pudding |
Oral
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Not Covered
|
Special Authorization (RD)
|
Limited Use (NIHB)
|
| Ensure Plus - Vanilla Oral Liquid |
Pediatric, 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)
|
| Ensure Protein MAX Oral Liquid |
Adult, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Ensure Regular Oral Liquid |
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)
|
| Essential Care Junior Powder |
Pediatric, Oral
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Gelmix Infant Thickener |
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)
|