The return of Similac Sensitive and Total Comfort - PowerPoint Presentation

Slide1

The return of Similac Sensitive and Total Comfort

Coming 1/3/2017

Slide2

So many formula choices!!

Slide3

So why do we need 2 more?

Slide4

Let’s talk about that,

shall we?

Slide5

These formulas used to be on WIC, then in 2014 Abbott reformulated three formulas to be 19

calories per ounce.

Similac

for Spit-Up

Similac

Sensitive

Similac

Total Comfort

Slide6

According to WIC rules, WIC formulas must meet the Standard of Identity set by FDA, unless they are a medical formula.

Standard

of Identity

for infant formulas:

Must provide at least 20 calories per fluid ounce standard dilution

Must provide at least 10 mg iron per liter standard dilution

Must not require the addition of any ingredient other than water prior to being served

Must meet the FDA definition and requirements for infant formula

Must be designed for oral or tube feeding use

Uh-oh!

Slide7

So, 19 calorie Abbott Formulas didn’t meet the requirements.

Similac

for Spit-Up

Similac

Sensitive

Similac

Total Comfort

Kept as a medical formula, requiring a medical documentation form

Removed from WIC in February 2014

Slide8

Since then, we have been listening to the concerns of WIC families, health care providers and you.

Slide9

What we learned…

These formulas are rebated after all. That means they cost the program less than we originally thought.

There are situations where babies that didn’t tolerate standard formula may have been able to use these less expensive alternative formulas, instead of more expensive medical formulas.

We can provide them with medical documentation.

$

Slide10

What is the difference between standard, alternative, or medical formulas?

For example

Slide11

What are they made of?

Similac

Advance

Gerber Good Start Soy

Similac

Sensitive

Similac

Total Comfort

Protein

Milk-based (60% casein

and 40% whey)

Soy protein

Milk-based

(82%

casein and

18% whey)

Milk-based (

100% p

artially

hydrolyzed whey)

Carbohydrate

100% lactose

Lactose free

53% maltodextrin

43%

sucrose

2% lactose from prebiotic

76% corn syrup solids

20% sucrose

2% lactose from prebiotic

Wording from manufacturer

Vegan, not indicated for prematurity

An alternative to standard milk-based formulas. For mild tolerance symptoms such as fussiness and gas due to lactose sensitivity. Suitable for infants with lactose sensitivity.

Formula with partially hydrolyzed whey protein that is an alternative to standard milk-based formulas with intact protein. For mild tolerance symptoms such as fussiness and gas due to lactose sensitivity.

Slide12

So when would you assign

Similac

Sensitive or Total Comfort, rather than the standard

Similac

Advance or Gerber Good Start Soy?

Slide13

First - what we know about formula intolerance has not changed

Lactose intolerance in infants is rare.

Primary lactase deficiency will present as severe

diarrhea

within the first few days of life.

Secondary lactase deficiency is temporary, usually due to an insult to the GI tract, it resolves with time.

Parents reporting their baby is “not tolerating” the formula usually appears

around 2 months and

generally resolves

by 6-7

months.

If infant presents with protein intolerance, allergy-don’t mess around! These formulas are not appropriate for protein allergies.

Slide14

Assign

Similac

Sensitive or

Total Comfort

Only to healthy full term infants

For formula intolerance that doesn’t require a lactose “free” formula

When the

family

has a completed med doc form requesting it

When the family’s medical provider is willing to complete a med doc form requesting it

Do not

assign for protein allergy

Slide15

What assessment would you do?

What formulas have you tried?

Tell me about how you mix up a bottle of formula? What do you do with the formula after you mix it?

How much do you put in each bottle and how much does baby drink?

How can you tell if the baby is hungry or full?

Describe what a poopy diaper looks like?

How does your baby act

after they drink

Similac

Advance?

Slide16

The infant mid certification appointment is an ideal time to check in and trial

back to a different formula.

Talk with your WIC nutritionist to see if an infant on a medical formula may tolerate an alternative formula as they get older.

Check in at the mid-cert

Slide17

Medical Documentation will be required for alternative formulas

A new section on the Medical Documentation form (MDF) will be used just for alternative infant formulas

Updated forms will be sent in December

Current forms can be used if needed

Slide18

Health Care Providers will use this section of the MDF for alternative formulas

19 kcal/

oz

alternative

Condition, not medical diagnosis

Formula amount and length of issuance default to maximum unless the HCP says differently

Slide19

New back of the MDF

Sections for standard, alternative, and medical formulas

Describes WIC

formulas characteristics and medical reasons to use formulas

Note: Contract = rebated

The med doc form is still being finalized, so you may see minor changes from this version.

Slide20

Med Doc Requirements

Same as any formula that needs med doc

Food package must

be assigned by a CPA

Can issue one month without med doc

Completed form must be reviewed and signed by your WIC nutritionist

No special formula trial or experiment required

Slide21

This change may be a great time to reach out to providers in your area with some new Med Doc forms and the Provider Tool Kit.

Slide22

Available to assign in TWIST starting 1/3/2017

Similac

Sensitive

P

owder 12 ounce can (

template)

Ready

to

feed 32 ounce bottle (template)

Ready to feed 8 ounce bottle 6-pack (available by searching in the modify screen)

Concentrate is not available in a retail version

Similac

Total

Comfort

Powder 12

ounce can

only – (template)

Slide23

Making a switch from one formula to another

There is no need to switch if the baby is doing fine on their current formula

Might be good to try it rather that switch all at once (Consider modifying the package to provide some of both formulas during the transition)

If no benefits have been spent, select the new template, forecast,

and re-issue

If spent benefits, will need to modify this month, then select template and forecast for future months,

and re-issue

Slide24

Finding the formula

Make sure families can find the formula since stores have no minimum stocking levels.

Powdered must be purchased in the 12 ounce cans, not the larger tub size.

If not available in the grocery section, go to the pharmacy and order the formula. This takes a few days.

These formulas are not available from the formula

warehouse.

Slide25

Resources for staff and participants

We want to support the great work of WIC staff to promote infant cues and developmental feeding

Consider revisiting training materials:

Infant formula module

Infant formula decision process job aid

What is normal, when to refer job aid

Participant handouts: common infant problems (now available to order on

Shopify

)

Slide26

What would you do?

Talk through these case studies

Slide27

Case Study 1 - Donnie

Mom reports that four month old Donnie has been fussy and gassy ever since he had a tummy bug a month ago. His poops are back to normal and he seems to be gaining weight, but mom worries that the

Similac

Advance formula is causing a problem. She said her friend recommended

Similac

Sensitive because it worked for her baby. She hasn’t talked to her doctor about changing because she can get the formula at the grocery store.

What assessment would you do?

What suggestions would you make?

Would you switch formulas for Donnie?

Slide28

Case Study 2 - Penny

Michelle is here for Penny’s first WIC appointment. Penny is a little over a month old. She is mostly breastfeeding Penny, but will be returning to work in a couple of weeks and will be supplementing with formula. She did the same thing with her older child and found that

Similac

Advance didn’t work.

Similac

Total Comfort worked well, but she ended up having to use

Nutramigen

from WIC. Her doctor has given her a med doc for

Similac

Total Comfort for Penny.

What assessment would you do?

What suggestions would you make?

What formula would you assign Penny?

Slide29

Case Study 3 - Mikey

Mikey is seen for the first time at 6 weeks of age. Mom, Karen, reports concerns regarding hives, crying, gas and sometimes blood in Mikey’s diaper. Mom is requesting a new formula today to see if that might help. Mikey has an appointment to see the doctor early next week.

What assessment would you do?

What suggestions would you make?

What formula would you

assign?

Slide30

Questions?

Talk to your local agency nutritionist. They will be the expert on the participants you are serving.Talk with your state nutrition consultant

Thank you for helping us out!

You’re the best!