The Wyoming WIC program asked that Wyoming Medicaid transition to reimburse for specialty formulas for medical indications. To that end, Wyoming Medicaid would like to provide the following clarifying information to clients and providers:
For all children who are using Similac Advance, Similac Sensitive, Similac Total Comfort, or Similac Soy Isomil formulas, there is no change in the process for families to receive formula at the WIC office.
For children who are 0-2 years old who are receiving other specialty formulas, families can obtain the formula from their pharmacy using their Medicaid pharmacy benefit. Providers who are prescribing a formula in this category will need to complete and submit a Medicaid Pharmacy Prior Authorization request. The PA request form can be found at: https://www.wymedicaid.org/content/dam/ffs-medicare/wy/pa-forms/wyoming-medicaid-miscellaneous-pa-form.pdf.
Providers may contact the Medicaid Pharmacy Help Desk at 1-877-209-1264 or the Provider PA Help Desk at 1-877-207-1126.
For children who are 3-4 years old who are receiving other specialty formulas for medical indications (e.g. weight loss, malabsorption, PEG feeding), providers will need to complete an order form found at: https://health.wyo.gov/wp-content/uploads/2025/07/Certification-of-Medical-Necessity-for-Enteral-Nutritionfillable.pdf
This form can be taken to a durable medical equipment (DME) provider. These will not be filled by pharmacies.
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● AeroCare Holdings – (307) 638-2162
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