If you are interested in having Kate Farms products covered by insurance, you will need a prescription from a licensed healthcare provider. This could be a physician, physician’s assistant, nurse practitioner, or in some states, a registered dietitian.

Before starting formula, here are some helpful questions to ask your provider that may influence whether insurance will provide coverage.

Are you familiar with Kate Farms?

If your provider is not familiar with Kate Farms, you can guide them to the clinician's section of katefarms.com. There, they can review our formulas, explore clinical use indications, connect with a sales representative, or speak with one of our on-staff registered dietitians. Let your provider know why you are interested in Kate Farms. Your preferences matter, and your provider will only know if you share them.

If your provider is already familiar with Kate Farms, that’s a great first step. You can continue the conversation by sharing why this formula is important to you.

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Which Kate Farms formula is right for me?

Your healthcare provider will determine which formula best supports your nutritional needs. For example, if you require a more easily digested protein, a peptide formula may be recommended. If you need additional calories to support weight gain or maintenance, your provider may suggest a formula with a higher caloric density.

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How much of my diet will come from formula, and is it medically necessary?

Understanding how much of your diet will be made up of formula is helpful for both your health plan and insurance coverage. Most insurance plans only cover formula when it is considered medically necessary. If you will be using formula as your sole source of nutrition because you are unable to consume other foods, coverage is more likely, though some programs like Medicare may have specific exclusions. If the formula is being used alongside solid foods, be sure to clarify whether your provider considers it medically necessary. If it is not, the best option may be to purchase your formula directly online.

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How long will I need formula?

Asking whether your need is temporary or long-term can help set expectations around cost, coverage, and ongoing use. If the need for formula is short-term, such as less than three months, insurance coverage may be unlikely. In that case, purchasing online may be the most efficient route. If formula will be part of your care long-term, coverage is more likely. Even if you are not initially eligible, your circumstances may change, so it’s a good idea to check with your insurance provider periodically.

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Will you send a prescription and documentation to a home medical supplier?

In order for insurance to consider covering your formula, a prescription must be sent to a home medical supplier who can verify your benefits. If you are eligible, the supplier will bill your insurance and ship the formula directly to your home.

A prescription may be enough for standard formulas, but for peptide formulas, insurance companies often require additional documentation. This may include clinical notes explaining why the formula is medically necessary. The home medical supplier may need to contact your provider again to complete the paperwork, which can delay the process. Asking your provider to include all necessary documentation when sending the prescription can help streamline the approval process.

If your provider is unsure which home medical supplier to use, contact Kate Farms. We can help guide you on where the prescription should be sent based on your specific insurance plan.

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