| Pediasure Plus with Fibre Oral Liquid |
Pediatric, Oral
|
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)
|
| Pediasure Vanilla Oral Liquid |
Pediatric, 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)
|
| Pediasure with Fibre Oral Liquid |
Pediatric, 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)
|
| Peptamen 1.0 |
Adult, 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
|
| Peptamen 1.0 with Prebio |
Adult, Oral
|
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)
|
| Peptamen 1.5 |
Adult, Oral
|
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)
|
| Peptamen 1.5 Vanilla |
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
| Peptamen AF 1.2 |
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
|
| Peptamen Intense |
Pediatric, Adult, Oral
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
Regular Benefit - needs Prescription
|
Not Covered
|
| Peptamen Junior 1.0 |
Pediatric, Oral
|
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)
|