Expedited Infant Formula Process for Members in Both the Women, Infants, and Children Program and Wisconsin Medicaid

Due to the Abbott recall, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is experiencing an infant formula supply shortage. For this reason, the prior authorization (PA) process for submitting infant formula PA requests for members concurrently enrolled in the WIC Program and BadgerCare Plus and Wisconsin Medicaid has been expedited, effective immediately.

The expedited PA process for infant formula is temporary and is only for members enrolled in both WIC and BadgerCare Plus and Wisconsin Medicaid. It will remain in effect for six months or until the infant formula supply has been stabilized. (See below for more information.) The expedited PA process does not apply to PA requests for infant formula that are submitted for BadgerCare Plus and Wisconsin Medicaid members who are not enrolled in WIC.

During the infant formula supply shortage, if a WIC agency does not have an adequate supply of formula, the WIC agency, not the prescribing provider or the vendor, initiates the PA request to ForwardHealth.

The following steps must be taken in the order shown:

1. If not already completed, the prescribing provider (physician, physician assistant, or nurse practitioner) fills out the Wisconsin WIC Request for Medical Formula/Food: Infants and Children form, F-44024D (09/2021).
2. The parent or caretaker contacts their preferred vendor (medical equipment vendor, medical supply provider, or pharmacy provider) to confirm the formula’s availability.
3. The parent or caretaker notifies their WIC agency of their preferred vendor. The parent or caretaker also provides their consent that WIC may send the Wisconsin WIC Request for Medical Formula/Food: Infants and Children form to ForwardHealth.
4. The WIC agency faxes the Wisconsin WIC Request for Medical Formula/Food: Infants and Children form and the Wisconsin WIC Medicaid/Vendor Communication Attachment, completed by the WIC agency, to ForwardHealth at 608-221-8616.
5. ForwardHealth completes the PA request with the submitted information from the WIC agency and assigns a PA number.
6. ForwardHealth communicates (through phone or email) the PA number directly to the vendor (medical equipment vendor, medical supply provider, or pharmacy provider) distributing the formula.

For claims submitted for reimbursement associated with the expedited PA process for members in both WIC and BadgerCare Plus and Wisconsin Medicaid, the vendor (medical equipment vendor, medical supply provider, or pharmacy provider) submitting the claim must email the following information to DHSBCPPGeneral@dhs.wisconsin.gov:

• The PA number
• The unique claim number (also known as the internal control number [ICN])

These claims submitted for infant formula during the supply shortage will be reimbursed fee-for-service and should not be submitted to a member’s HMO.

For dates of service on and after October 20, 2022, the permanent PA and claim submission policies for infant formula will again apply. If the infant supply shortage ends before October 20, 2022, ForwardHealth will notify providers of the adjusted end date to the temporary policy.

For questions about the expedited PA process for infant formula requests for members in both WIC and BadgerCare Plus and Wisconsin Medicaid, providers may contact Provider Services at 800-947-9627.