I'm sorry, but the clinic nurse may be a great nurse, but she's clueless about nutrition. Your PALS' primary care physician can prescribe whatever food your PALS prefers. Perhaps he doesn't care about one of the three real food options and he's fine with the other, in which case he should just go with it. If he prefers real food, he may have to fight a little for it... starting with pushing on past the clinic nurse and finding someone who will write a script. Nobody outside of your family can tell your PALS what he can and can't eat. It's all a function of what, and how much, insurance will cover and how comfortable you are with the out-of-pocket. To answer your earlier question, we did pay some out-of-pocket but we managed.