For Health Care Providers


All MaineCare Prior Authorizations should be forwarded to Due to the COVID-19 pandemic, we will have very limited access to our fax machine. Thank you for understanding.

COVID-19 Announcement (PDF)

WIC Covid-19 poster

WIC provides breastfeeding counseling, support and education to all pregnant and breastfeeding women. WIC also provides loaner breast pumps to breastfeeding mothers.

Infants who are not exclusively breastfed can be provided formula, up to the WIC Maximum Monthly Amount (Excel). If a non-standard formula is medically indicated, please complete the Prior Authorization form below.

Medical Documentation and Prior Authorization Form

Baby getting a medical exam

This form is required before non-standard/medical formula can be provided to WIC participants. Health care providers, please follow these steps:

  • Download the form in Word or PDF format
  • Fill out form
  • Fax it to your local WIC office or to the State WIC Agency by e-faxing to or traditional fax at 207-287-3993.

Former Standing Order Forms

The standard Abbott Similac contract formulas that were previously 19kcals/oz (Sensitive, Total Comfort, and Spit-Up) have been reformulated to 20kcals/oz and no longer require our Standing Order Form.

OB-GYNs and Maine WIC: a vital partnership

We don't have to tell you twice…Appropriate prenatal care for your patient is critical for health pregnancy outcomes. Let WIC help. Referring your patients to WIC for a continuity of prenatal and postpartum care helps ensure moms and babies are receiving breastfeeding support, good nutrition guidance and the critical opportunity to raise healthy families. Call us at 207-287-3991 or email to request copies of our WIC brochure to assist in referring patients to WIC or copies of our WIC infographic to share the importance of WIC with your colleagues and staff.

Health Care Provider Food Insecurity Toolkit

Food insecurity is a real issue for Maine families. Health care providers can help to identify those families who need assistance with this most basic of needs. The Health Care Provider toolkit can help you in your work with the patients you see every day.

The kit includes:

If you would like hard copies of any of these materials, do not hesitate to contact the Maine CDC WIC Nutrition Program office at 207-287-3991 or send your request to us at /dhhs/mecdc/population-health/wic/contact.shtml

Thank you for all you do to assist in identifying families in your practice who may benefit from Maine's nutrition programs.

Maine CDC WIC Nutrition Program Formulary - Updated October 2021

The Maine CDC WIC Formulary includes standard and medical formulas. All prescription formula request for items not included on our Formulary are evaluated biannually through an internal submission review process. These reviews take place in June and January. If your organization has a request for an exempt formula or qualifying nutritional, please forward the formula information and include the UPC and formula product label (manufacturer product website page, if possible) to Only contract brand standard formulas can be provided.

Provision of Ready To Feed (RTF) formulas:

WIC staff may provide ready to feed (RTF) infant formulas for a WIC participant only when assessment determines that at least one of the following conditions exists:

  • The participant's household has an unsanitary or restricted water supply or poor refrigeration
  • The person caring for the participant may have difficulty in correctly diluting concentrated or powdered formulas
  • The formula is only available in ready-to-feed form.

Participants with a prescription for a medically necessary formula (non-standard formula, exempt formula, WIC-eligible nutritional) may be provided RTF formula for the following additional reasons:

  • The ready to feed form better accommodates the participant’s condition
  • The ready to feed form improves the participant’s compliance in consuming the prescribed WIC formula

For information on RTF forms of specific formulas, consult the appropriate section of the WIC formulary.