Can You Get a Prescription for Ensure Drink? A Guide to Coverage and Medical Necessity

December 30, 2025 •

4 min read

In many cases, health insurance providers, including Medicaid, will cover Ensure or similar nutritional drinks, provided certain medical criteria are met. The key to securing coverage often lies in obtaining a formal prescription and documenting the medical necessity for the Ensure drink.

Quick Summary

Obtaining a prescription for Ensure is possible if a doctor determines it is medically necessary due to malnutrition, weight loss, or difficulty swallowing. Insurance coverage, particularly for Medicaid, depends on a physician's order and comprehensive documentation.

Key Points

Medical Necessity is Key: A prescription for Ensure is only given when a doctor certifies it as medically necessary for conditions like malnutrition, dysphagia, or chronic illness.
Insurance Can Cover the Cost: Health insurance, including Medicaid, may cover the cost of Ensure if prescribed, though coverage varies by plan and state.
Documentation is Required: To secure coverage, your doctor must provide a written order and medical documentation that justifies the nutritional need.
Not a First-Line Treatment: Healthcare providers often recommend trying a 'food first' approach to improve nutrition before prescribing oral nutritional supplements like Ensure.
Alternatives are Available: Ensure can be purchased over-the-counter without a prescription, and homemade nutritional shakes are also an option, though these are not insurance-covered.
Check for Potential Side Effects: While generally safe, Ensure can cause side effects like gastrointestinal upset and may interact with certain medications, so always consult a doctor.

When Can You Get a Prescription for an Ensure Drink?

While Ensure can be purchased over-the-counter without a prescription, getting a prescription is the critical step toward securing insurance coverage. A healthcare provider, such as a doctor or registered dietitian, must certify the product is 'medically necessary' for your condition. This status is reserved for individuals with specific health needs that cannot be met through diet alone. Typically, the healthcare provider will recommend a 'food first' approach, where dietary changes are attempted for a period of several weeks before prescribing oral nutritional supplements.

Conditions That May Warrant Medical Necessity

Several medical conditions and circumstances can lead to a doctor prescribing a nutritional supplement like Ensure. These include:

Documented Malnutrition or Significant Weight Loss: If a patient is underweight or has experienced substantial unintentional weight loss, a supplement may be necessary to restore their health.
Difficulty Swallowing (Dysphagia): For individuals who have trouble chewing or swallowing solid food, liquid nutritional supplements can be a safer and more efficient way to consume calories and nutrients.
Chronic Illnesses: Certain long-term conditions, such as cancer, Crohn's disease, or HIV/AIDS, can affect appetite and nutrient absorption, necessitating supplemental nutrition.
Post-Surgery Recovery: Patients recovering from surgery may have increased nutritional requirements or temporary difficulty eating, for which Ensure could be prescribed.

Navigating the Process of Getting Your Prescription

Securing a prescription and subsequent insurance coverage for Ensure involves several steps and requires cooperation between you and your healthcare provider. The process is a careful one to ensure the product is used appropriately.

The Steps to Take

Consult Your Doctor: Discuss your nutritional concerns with your primary care physician or a specialist. They will conduct a medical evaluation to determine the root cause of your nutritional issues.
Trial a 'Food First' Approach: Your doctor or dietitian may initially recommend modifying your diet with nutrient-dense, whole foods. This may be required for a specified period (e.g., four weeks) before moving to supplements.
Obtain a Written Prescription: If the food-first approach fails or if your condition is severe, your doctor can write a formal prescription. This order will specify the product (e.g., Ensure Plus), the quantity, and the duration.
Complete Prior Authorization: Your insurance provider, particularly Medicaid, may require a prior authorization form to be filled out. This typically involves submitting your prescription along with supporting medical documentation that proves the clinical need.
Submit Documentation: You or your doctor’s office will need to submit this paperwork to your insurance plan. Companies like Pathway Plus offer services to help with this reimbursement process.

Over-the-Counter vs. Prescription Ensure: A Comparison

To understand the benefits of a prescription, it's helpful to compare the two methods of obtaining the product.


Feature	Over-the-Counter Purchase	Prescription Purchase
Purchase Method	Sold directly off the shelf at pharmacies, grocery stores, or online retailers.	A doctor provides a written order, and the purchase is facilitated through a pharmacy.
Eligibility	No restrictions. Anyone can buy the product.	Must be deemed medically necessary by a healthcare provider for a specific condition.
Cost & Coverage	Paid out-of-pocket by the consumer.	May be fully or partially covered by health insurance (e.g., Medicaid), potentially resulting in significant savings.
Documentation	No medical documentation is required.	Requires a formal prescription and medical records to justify the need for the supplement.
Professional Guidance	Purchase is self-directed. Consumers may consult a pharmacist but do not have a formal plan.	The dosage, type of product, and duration are part of a medically supervised plan.

Important Considerations and Potential Side Effects

While Ensure and other nutritional shakes are generally safe, it is important to be aware of potential side effects and interactions, particularly when using them as a supplement for a medical condition. Your healthcare provider's guidance is paramount.

Potential Side Effects

Gastrointestinal Upset: Common side effects include nausea, bloating, and constipation or diarrhea, especially when first starting the supplement. These often lessen with consistent use.
Interactions: High levels of certain vitamins, like vitamin K in some formulations, can interfere with blood-thinning medication such as warfarin. It is crucial to discuss all supplements with your doctor.
Allergies and Conditions: Ensure products are generally lactose-intolerance friendly but are not safe for people with galactosemia, a genetic disorder.

The Role of Insurance and Reimbursement Support

Different insurance plans and state regulations dictate whether nutritional supplements are covered. The key is proving medical necessity through a doctor's order and submitting the necessary paperwork. Many companies offer reimbursement support services, which can assist with navigating the complex process of obtaining prior authorizations and verifying coverage. In regions like New Zealand, there are specific funding criteria and potential part-charges for certain branded products.

For more detailed information on the concept of 'medical necessity' as it applies to insurance, you can consult resources from authoritative bodies like the National Association of Insurance Commissioners (NAIC).

Conclusion: A Clear Path to Medically Necessary Nutrition

Yes, you can get a prescription for an Ensure drink, but it is not a casual request. It is part of a deliberate, medically-supervised process for patients with documented nutritional needs. From trying a 'food first' diet to securing a doctor's order and navigating insurance requirements, the path to obtaining Ensure via a prescription is clear. For those who don't meet the criteria, the product remains available for over-the-counter purchase. Always work with your healthcare team to ensure the best and safest approach for your nutritional health.

Frequently Asked Questions

No, you do not need a prescription to buy Ensure. It is available over-the-counter at most pharmacies and grocery stores for anyone to purchase.

The main reason to obtain a prescription is to potentially get insurance coverage for the cost of the nutritional drinks. Without a prescription, you will pay the full retail price.

Yes, Medicaid may cover Ensure or similar nutritional supplements for adults and children if it is deemed medically necessary and supported by a physician's order. Coverage details and requirements vary by state.

A prescription may be deemed medically necessary for conditions involving documented malnutrition, significant weight loss, chronic illnesses like cancer or Crohn's disease, or difficulty chewing and swallowing.

A doctor must provide a written prescription or order, along with medical documentation that proves the nutritional risk or clinical need, such as an official diagnosis code.

Common side effects include gastrointestinal issues like nausea, constipation, bloating, and gas. These symptoms often subside after a few days of consistent use.

Yes, other oral nutritional supplements like Boost and Glucerna are available, and some may be covered by your plan. Homemade alternatives can also be made with protein-rich ingredients.

For most state Medicaid programs and many private insurance plans, a prescription is almost always required to prove medical necessity before they will consider covering the cost of nutritional supplements.