| Lipistart |
Infant, 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
|
| Lipistart |
Pediatric
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
| Liquid Protein |
Infant, Pediatric, Adult, Modules
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| MCT Oil Oral Liquid |
Infant, Pediatric, Adult, Modules
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Special Authorization (RD)
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Neocate Infant DHA/ ARA Powder |
Infant, Oral
|
Special Authorization (MD Only)
|
Special Authorization (MD Only)
|
Special Authorization (MD Only)
|
Special Authorization (MD Only)
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Neocate Junior Powder |
Pediatric
|
Special Authorization (MD Only)
|
Special Authorization (MD Only)
|
Special Authorization (MD Only)
|
Special Authorization (MD Only)
|
Regular Benefit - needs Prescription
|
Special Authorization (MD Only)
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Neocate Junior with Fibre Powder |
Pediatric
|
Special Authorization (MD Only)
|
Special Authorization (MD Only)
|
Special Authorization (MD Only)
|
Special Authorization (MD Only)
|
Regular Benefit - needs Prescription
|
Special Authorization (MD Only)
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Neocate Splash Oral Liquid |
Pediatric, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Limited Use (NIHB)
|
| Nephea Kid |
Pediatric, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Nephea Kid - ACH |
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|