EN Infant Formulas

Term Infants; Polymeric | Term Infants; Hydrolyzed | Preterm Infants; Polymeric

Preterm Infants; Partially Hydrolyzed | Preterm Infants; Hydrolyzed

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Term Infants; Polymeric

Composition Formula Brand Name, Manufacturer Features HCPCS Code Specifics
Milk based/Whey protein Advantage Infant Formula®, Up and Up (Target) DHA, Lutein, Vitamin E; 20 kcal/oz Contains soy
Enfamil® EnspireTM, Mead Johnson DHA, lactoferrin, 20 cal/oz, non-GMO B4158 Contains soy
Enfamil NeuroPro Infant®, Mead Johnson DHA, 20 cal/oz, non-GMO, whey/casein 60/40 B4158 Contains soy
Enfamil Premium Newborn®, Mead Johnson DHA, 20 cal/oz, non-GMO, whey/casein 80/20 B4158
Enfamil® Infant, Mead Johnson DHA, 20 cal/oz, whey/casein 60/40 B4158 Contains soy
Infant Non-GMO Formula®, Up and Up (Target) 20 cal/oz, prebiotics, non-GMO Contains soy
Natura Stage 1 Organic Infant Formula®, Gerber DHA, 20 cal/oz, prebiotics, non-GMO Contains soy
Natura Stage 2 Organic Infant Formula®, Gerber DHA, 20 cal/oz, prebiotics, non-GMO Contains soy
Organic Dairy Infant Formula®, Earth's Best DHA, lutein, prebiotics, non-GMO Contains soy
Organic Dairy Infant Formula - Non DHA®, Earth's Best Lutein, 20 cal/oz, non-GMO Contains soy
Pure Bliss by Similac®, Abbott Lutein, DHA and Vitamin E, 19 cal/oz, Non-GMO Contains soy
Similac Pro Advance®, Abbott Lutein, DHA and Vitamin E, Human milk oligosaccharides; 19 cal/oz Contains soy
Similac Advance®, Abbott Lutein, DHA and Vitamin E, Nucleotides; 19 cal/oz Contains soy
Similac Advance 20®, Abbott Lutein, DHA and Vitamin E, Human milk oligosaccharides; 20 cal/oz Contains soy
Similac Organic®, Abbott Lutein, DHA and Vitamin E, Human milk oligosaccharides; 19 cal/oz Contains soy
Similac for Supplementation Non GMO®, Abbott Lutein, DHA and Vitamin E, Human milk oligosaccharides; 19 cal/oz Contains soy
Similac Advance for Neuro Support®, Abbott Lutein, DHA and Vitamin E, Nucleotides; 19 cal/oz Contains soy
Similac® with Iron 24, Abbott DHA; 24 cal/oz Contains soy
Milk based/whey and casein Added Rice Starch Infant Formula with Iron, Up and Up (Target) 20 cal/oz, prebiotics, DHA, added rice starch, Contains soy
Holle Stage 1 Organic (Bio) Infant Milk Formula, Organic Start 20 cal/oz, non-GMO
Holle Stage Pre Organic (Bio) Infant Milk Formula, Organic Start 20 cal oz, no maltodextrin, reduced vegetable oil, whole milk fat, non-GMO
Organic Premium Infant Formula With Iron, The Honest Company DHA, 20 cal/oz, FOS, non-GMO Contains soy
Organic Premium Infant Formula with Iron, Plum® Organics DHA, 20 cal/oz, non-GMO Contains soy
Organic Sensitivity® Infant Formula, Earth's Best DHA, lutein, 20 cal/oz, reduced lactose Contains soy
Organic Sensitive Infant Formula with Iron, The Honest Company DHA, 20 cal/oz, FOS, non-GMO, reduced lactose Contains soy
Similac® PM 60/40, Abbott Whey/casein 60/40; 20 cal/oz; low mineral content Contains soy
Milk based/milk protein isolate Enfamil NeuroPro™ Sensitive DHA, 20 cal/oz, non-GMO  
 Sensitivity® Infant Formula, Up and Up (Target)
DHA, lutein, prebiotics, non-GMO, reduced lactose Contains soy 
Similac Pro Sensitive®, Abbott Lutein, DHA and Vitamin E, Human milk oligosaccharides; 19 cal/oz
Similac Sensitive®, Abbott Lutein, DHA and Vitamin E, 19 cal/oz, Non-GMO Contains soy
Similac Sensitive for Neuro Support®, Abbott Lutein, DHA and Vitamin E, 19 cal/oz, Non-GMO Contains soy
Milk based/milk protein isolate with rice starch Enfamil A.R.®, Mead Johnson DHA, 20 cal/oz, whey/casein 20:80 B4158 Contains soy
Similac for Spit Up®, Abbott Lutein, DHA and Vitamin E, 19 cal/oz Contains soy
Similac for Spit Up-Non GMO®, Abbott Lutein, DHA and Vitamin E, 19 cal/oz, Non-GMO Contains soy
Soy protein isolate Enfamil® ProSobee®, Mead Johnson DHA, 20 cal/oz B4158 contains soy
Non-GMO Plant Based Formula®, Earth's Best DHA, 20 cal/oz Contains soy
Similac® Soy Isomil, Abbott Lutein, DHA and Vitamin E, Nucleotides; 19 cal/oz Contains soy
Similac® Soy Isomil 20, Abbott Lutein, DHA and Vitamin E, 20 cal/oz Contains soy
Similac® for Diarrhea, Abbott Soy fiber; 20 cal/oz Contains soy
Goat milk Holle Goat Stage 1 Organic Bio Infant Milk Formula®, Organic Start 19.5 cal/oz

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Term Infants; Hydrolyzed

Composition Formula Brand Name, Manufacturer Features HCPCS Code Specifics
Milk based/whey protein hydrolysate Good Start® Gentle (HMO) Powder®, Gerber DHA, prebiotic, 20 cal/oz, non-GMO Contains soy
Good Start® Gentle®, Gerber DHA, prebiotic, 20 cal/oz, non-GMO Contains soy
Good Start® Soothe (HMO)®, Gerber DHA, prebiotic, 20 cal/oz, non-GMO, reduced lactose Contains soy
Enfamil® Gentlease®, Mead Johnson DHA, 20 cal/oz, whey/casein 60/40 B4158 Contains soy
Enfamil NeuroPro® Gentlease®, Mead Johnson DHA, 20 cal/oz, non-GMO B4158 Contains soy
Enfamil® Reguline®, Mead Johnson DHA, 20 cal/oz, whey/casein 60/40 B4158 Contains soy
Similac Pro Total Comfort®, Abbott Lutein, DHA and Vitamin E, human milk oligosaccharides, 19 cal/oz; non-GMO Contains soy
Similac Total Comfort®, Abbott Lutein, DHA and Vitamin E, 19 cal/oz Contains soy
Similac Total Comfort Non-GMO®, Abbott Lutein, DHA and Vitamin E, 19 cal/oz; non-GMO Contains soy
Gentle® Infant Formula With Iron, Up and Up (Target) 20 cal/oz, non-GMO, reduced lactose Contains soy
Organic Gentle Infant Formula with Iron, Earth's Best DHA, 20 cal/oz, non-GMO Contains soy
Soy protein hydrolysate Good Start® Soy Infant Formula®, Gerber DHA, 20 cal/oz, non-GMO Contains soy
Whey hydrolysate Good Start® Extensive HA®, Gerber DHA, 20 cal/oz, non-GMO Contains soy
Casein hydrolysate Pregestimil®, Mead Johnson DHA and ARA, MCT, 20 cal/oz B4161 Contains soy 
Casein hydrolysate, free amino acids  Nutramigen®, Mead Johnson DHA, 20 cal/oz B4161 Contains soy
Casein hydrolysate, free amino acids  Nutramigen® with Enflora LGG®, Mead Johnson DHA, 20 cal/oz, LGG probiotic B4161 Contains soy
Casein hydrolysate, free amino acids Similac® Alimentum®, Abbott DHA and ARA, MCT, Vitamin E, 20 cal/oz
Free amino acids Elecare®, Abbott DHA, 20 cal/oz, MCT
Free amino acids PurAmino®, Mead Johnson DHA, 20 cal/oz, MCT B4161 Contains soy
Free amino acids Neocate® Infant DHA/ARA, Nutricia DHA, ARA, 20 cal/oz, MCT B4161
Free amino acids Neocate® Syneo® Infant, Nutricia DHA, 20 cal/oz, MCT, FOS probiotic B4161

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Preterm Infants; Polymeric

Composition Formula Name Features HCPCS Code Specifics
Whey protein Similac® Human Milk Fortifier Concentrated Liquid, Abbott Contains soy
Whey protein Similac® Human Milk Fortifier Powder, Abbott Contains soy
Whey protein Similac® Special Care® 20, Abbott DHA, Lutein, Vitamin E; 20 kcal/oz Contains soy
Whey protein Enfamil® Premature 20 Cal, Mead Johnson DHA, 20 cal/oz, whey/casein 80/20 B4160 Contains soy
Whey protein Similac® Special Care® 24, Abbott DHA, Lutein, Vitamin E; 24 kcal/oz Contains soy
Whey protein Enfamil® Premature 24 Cal, Mead Johnson DHA, 24 cal/oz, whey/casein 80/20 B4160 Contains soy
Whey protein Similac® Special Care 24 High Protein, Abbott DHA, Lutein, Vitamin E; 24 kcal/oz Contains soy
Whey protein Enfamil® Premature 24 Cal HP, Mead Johnson DHA, 24 cal/oz, whey/casein 80/20 B4160 Contains soy
Whey protein Similac® Special Care® 30, Abbott DHA, Lutein, Vitamin E; 30 kcal/oz Contains soy
Whey protein Enfamil® Premature 30 Cal, Mead Johnson DHA, 30 cal/oz, whey/casein 80/20 B4160 Contains soy
Whey protein Similac Neosure®, Abbott DHA, Lutein, Vitamin E; 22 kcal/oz Contains soy
Whey protein Enfamil NeuroPro™ EnfaCare®, Mead Johnson DHA, 22 cal/oz, whey/casein 80/20 B4160 Contains soy
Milk based/whey and casein PremieLact®, Prolacta Pasteruized donor breast milk
Prolact CR®, Prolacta Human milk caloric fortifier from pasteurized donor breast milk
Prolact HM®, Prolacta Pasteurized donor breast milk
Prolacta H2MF® (+4, +6, +8, +10), Prolacta Human milk fortifier from pasteurized donor breast milk
Prolact RTF ® 24/26/28, Prolacta Pasteurized donor breast milk

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Preterm Infants; Partially Hydrolyzed

Composition Formula Brand Name, Manufacturer Features HCPCS Code Specifics
Whey protein isolate hydrolysate Enfamil® Human Milk Fortifier Acidified Liquid, Mead Johnson B4155 Contains soy
Whey protein isolate hydrolysate Enfamil® Human Milk Fortifier Powder, Mead Johnson B4155 Contains soy

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Preterm Infants; Hydrolyzed

Composition Formula Brand Name, Manufacturer Features HCPCS Code Specifics
Casein hydrolysate Similac® Human Milk Fortifier Hydrolyzed Protein Concentrated Liquid, Abbott
Casein hydrolysate Liquid Protein Fortifier, Abbott

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