VA Criteria for Use Formulary Advisor Reference
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NOVASOURCE LIQUID,NUTRITIONAL SUPPLEMENT

Generic Name
NOVASOURCE LIQUID
Brand Names
NOVASOURCE RENAL 2 CAL
Drug Class
ENTERAL NUTRITION
Formulary Status
Prior Auth Required Formulary with prior authorization
Copay Tier
N/A
Last Updated
November 1, 2025

Clinical Criteria Summary

Inclusion Criteria

  • Provider is a VA / VA Community Care Nephrologist or Registered Dietitian
  • Patient has renal impairment

Source Documents

Download CFU PDF: NovaSource Renal CFU NOV 2025