Can you get meal replacement shakes on prescription? Understanding Medical Necessity and Coverage

October 19, 2025 •

4 min read

According to the Northern Care Alliance, prescription nutritional supplements are only recommended for individuals who need extra nourishment and cannot achieve this through diet and over-the-counter products alone. The ability to get meal replacement shakes on prescription is determined by a strict medical assessment, not as a general health or weight-loss tool.

Quick Summary

Obtaining prescription nutritional shakes requires a clinical diagnosis of malnutrition or other specific medical conditions. Eligibility is determined by a doctor and dietitian, often after other nutritional interventions prove insufficient.

Key Points

Medical necessity is key: Prescription meal replacements are for medically-diagnosed conditions like malnutrition, not general use or self-managed weight loss.
Assessment by a professional: Eligibility is determined by a doctor and often a dietitian based on specific clinical criteria, such as a high malnutrition risk score (MUST).
Food First approach: Healthcare providers typically encourage trying to boost nutrition through regular, fortified foods before prescribing supplements.
Qualifying conditions: Prescriptions are given for a range of conditions including cancer, chronic diseases, eating difficulties, and geriatric malnutrition.
Insurance limitations: Coverage varies significantly by insurer and public health system. It often requires prior authorization and proof of medical necessity.
Regular review: Prescriptions are not indefinite. They are regularly reviewed to monitor patient progress and ensure continued need.

When and Why are Meal Replacement Shakes Prescribed?

Prescription meal replacement shakes, technically known as Oral Nutritional Supplements (ONS), are a medical intervention, not a lifestyle choice. They are specifically formulated to provide a balanced mix of macro- and micronutrients for individuals unable to meet their nutritional needs through regular food. Unlike over-the-counter options, which are generally dietary aids, these medical products are regulated and intended for therapeutic use under professional supervision. A doctor or dietitian may prescribe ONS when an individual is at a high risk of malnutrition or is already malnourished due to a number of medical conditions.

The primary reasons for a prescription are based on a clinical assessment, which often includes calculating a patient's Malnutrition Universal Screening Tool (MUST) score. A high MUST score is a key indicator that food-first approaches are insufficient and that nutritional supplements are necessary.

Qualifying Conditions for a Prescription

A wide range of medical conditions can necessitate prescribed meal replacement shakes. These conditions often impact a person's appetite, ability to eat, or a body's capacity to absorb nutrients. Some of the most common reasons include:

Disease-related malnutrition: This is the principal indication for prescribing ONS and can occur with many acute and chronic illnesses.
Chronic diseases: Conditions like Chronic Obstructive Pulmonary Disease (COPD), cancer, inflammatory bowel disease (Crohn's, Ulcerative Colitis), and certain neurological conditions (e.g., Parkinson's disease, dementia) often lead to significant nutritional deficits.
Eating and swallowing difficulties: Individuals with dysphagia (difficulty swallowing) or other issues preventing solid food intake can be prescribed liquid nutritional supplements.
Post-operative recovery: Following major surgery, some patients may require ONS to support healing and prevent weight loss.
Geriatric care: Older adults who experience loss of appetite, mobility issues, or debility may require supplemental nutrition to combat sarcopenia (muscle loss) and malnutrition.
Type 2 Diabetes remission programs: Under strict medical supervision, some NHS programs have used total diet replacement shakes to help eligible individuals with type 2 diabetes achieve remission.
Inherited metabolic disorders: Some genetic conditions may require special low-protein or amino acid formulas.

The Role of a Healthcare Professional

Obtaining a prescription for meal replacement shakes is not a simple request. It is a multi-step process that involves a healthcare team. A general practitioner (GP) or specialist may refer a patient to a registered dietitian, who conducts a thorough nutritional assessment. The dietitian plays a crucial role in determining the patient's eligibility, selecting the most appropriate product, and creating a monitoring plan.

The process typically follows a 'Food First' approach, which involves trying to boost nutritional intake through regular foods and home-fortified drinks before resorting to supplements. If this approach proves unsuccessful after a trial period (often 4 weeks), the prescription for ONS is considered. Regular reviews are mandatory to monitor the patient's progress, re-assess their nutritional status, and decide whether to continue or discontinue the prescription.

Navigating Prescription vs. Over-the-Counter Shakes

It is important to differentiate between medically-approved prescription shakes and the wide variety of over-the-counter (OTC) products available at pharmacies or stores. The key difference lies in their purpose, composition, and regulation.


Feature	Prescription Meal Replacement Shakes	Over-the-Counter (OTC) Shakes
Purpose	Treat specific medical conditions (e.g., malnutrition).	Supplement diet, general health, or support weight loss.
Regulation	Subject to stringent medical and regulatory oversight.	Regulated as dietary supplements, less rigorous oversight.
Nutritional Content	Formulated to be nutritionally complete for medical needs.	Often focused on one macronutrient (e.g., protein) and may lack full nutritional balance.
Supervision	Requires assessment and ongoing monitoring by a healthcare professional.	Typically used without direct medical supervision.
Coverage	May be covered by insurance or national health services with medical necessity.	Purchased out-of-pocket by the consumer.
Formulation	Wide variety of formulas for specific needs (diabetes, renal, high energy).	One-size-fits-all approach, less specialized.

Coverage and Cost

Insurance and public health system coverage for prescription nutritional supplements is not guaranteed and depends on several factors. For coverage to apply, the supplements must be deemed medically necessary by a physician and align with the specific insurer's policy. Coverage can vary significantly by plan and state or region. For example, Medicare may cover formula for exclusive tube feeding but not for drinking, whereas Medicaid might cover drinking formula if medically necessary. In the UK, the NHS prescribes ONS based on local prescribing guidelines and clinical judgment, often involving dietetic review. Patients and caregivers must often navigate a prior authorization process with the insurer to prove medical necessity.

Conclusion: Medical Need, Not Personal Preference

In conclusion, the ability to get meal replacement shakes on prescription is a privilege reserved for those with a genuine medical need for therapeutic nutritional support. It is a process that requires a thorough medical evaluation and ongoing supervision by healthcare professionals, especially dietitians. While convenient, over-the-counter meal replacement shakes do not serve the same purpose and lack the specific nutritional formulation and oversight of their prescription counterparts. Attempting to use prescription shakes for non-medical reasons, such as self-managed weight loss, is not recommended and can be dangerous. For individuals with specific dietary needs due to illness, injury, or age, consulting with a healthcare provider is the crucial first step to accessing the right form of nutritional support. For comprehensive guidance on nutrition support and the use of oral nutritional supplements, authoritative resources can be found through organizations like the National Institutes of Health.

Frequently Asked Questions

A doctor can prescribe oral nutritional supplements (ONS) for conditions causing or risking malnutrition, including chronic diseases like cancer or COPD, inherited metabolic disorders, severe weight loss, or difficulties with eating and swallowing.

Coverage depends on the insurer and the specific plan. It is typically only available if a healthcare provider documents that the nutritional shakes are medically necessary for a diagnosed condition.

No, it is not typical to get a prescription for shakes for general weight loss. Medically supervised very low-calorie diets (VLCD) might involve shakes, but these are for specific clinical situations and are not prescribed for self-managed weight loss.

Prescription shakes are medically regulated and nutritionally complete products designed for specific therapeutic uses under medical supervision. Over-the-counter shakes are dietary supplements with less stringent regulation and are not intended for medical treatment.

An elderly person must be assessed by a doctor, who will check for indicators of malnutrition or weight loss. If a food-first approach is insufficient, a dietitian can determine the need for a medically necessary oral nutritional supplement.

You should start by consulting your doctor. They will evaluate your nutritional status, potentially using a screening tool like the MUST score, and may refer you to a registered dietitian for a comprehensive assessment.

Yes, prescription nutritional supplements come in various formats, including powdered or ready-to-drink options like milkshake, juice, or dessert styles. Specific formulas exist for various medical needs, such as high-energy or low-volume options.