Proposal to fully fund oral feed for adults with Crohn’s disease requiring exclusive enteral nutrition

What we’re proposing

We’re asking for feedback on a proposal to fully fund oral feed 1.5kcal/ml bottles for adults with Crohn's disease requiring exclusive enteral nutrition (EEN) in the community from 1 July 2025.

Consultation closes at 5:00pm, Wednesday, 4 June 2025 and feedback can be emailed to Consult@Pharmac.govt.nz

What would the effect be?

This proposal would mean that from 1 July 2025, adults with Crohn’s disease requiring EEN would be able to receive fully funded oral feed 1.5kcal/ml, 200ml bottles in the community and would not be required to pay a manufacturers’ surcharge.

This proposal follows a decision by Abbott to discontinue its Ensure Plus HN cans, which were previously available as a fully funded option for adults with Crohn’s disease requiring EEN.

We anticipate that up to 200 adults per year could access fully funded standard supplements for EEN for the management of their Crohn’s disease.

Who we think will be interested

• Adults with Crohn’s disease currently receiving an EEN diet or considering an EEN diet for the management of their Crohn’s disease.
• Dietitians, gastroenterologists and other staff who treat and support people with Crohn’s disease in New Zealand in Health NZ | Te Whatu Ora hospital settings.
• Primary health care workers who support people living with Crohn’s disease.
• Whānau, families, partners, loved ones and caregivers of people living with Crohn’s disease.
• Patient support groups
• Pharmacies and pharmacy staff
• Wholesalers
• Manufacturers and suppliers

About Crohn’s disease, exclusive enteral nutrition (EEN), and oral feed 1.5kcal/ml 200 ml bottles

Crohn’s disease

Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract, which can penetrate deep into the bowel wall, resulting in abscesses and fistulae.

Crohn’s disease is a type of inflammatory bowel disease (IBD) characterised by a relapsing and remitting pattern of symptoms which commonly include diarrhoea, abdominal pain and cramping, blood in the stool, reduced appetite, weight loss and fatigue.

Periods of relapse are typically treated with therapies such as immunosuppressants and glucocorticoids, followed by anti-TNF agents. In some patients, Crohn’s disease requires surgical management. This proposal would provide another option for people with Crohn’s disease.

Exclusive Enteral Nutrition (EEN)

EEN is a diet where all food and drink is replaced with specialised liquid formula and water. The specialised formulas are nutritionally complete which means they meet all a person’s nutritional needs, including calories, protein, vitamins, and minerals. For people with Chron’s disease EEN is typically taken orally (drunk) for a period of 4-12 weeks. The aim of EEN in Crohn’s disease is to reduce inflammation and induce remission.

Oral feed 1.5kcal/ml 200ml bottles

Pharmac currently funds two brands of oral feed 1.5kcal/ml, 200 ml bottles. They are listed in Section D of the Pharmaceutical Schedule for use in the community as follows:

Brand	Subsidy	Quantity
Ensure Plus	$0.72 ($1.56)	200 ml bottle
Fortisip	$0.72 ($1.76)	200 ml bottle

Since 2011, Ensure Plus and Fortisip have been funded in the community subject to reference pricing, which means they are partially funded for most people.

For oral feed 1.5kcal/ml, 200 ml bottles, Pharmac pays a subsidy of $0.72 per bottle and people are required to pay the difference between $0.72 and the manufacturers’ list prices ($1.56 or $1.76). This is known as a manufacturers’ surcharge. Pharmacies may charge additional margins on the manufacturers’ surcharge meaning that the actual cost paid by people may be higher.

People in particular clinical situations can receive an additional subsidy by endorsement for oral feed 1.5kcal/ml, 200 ml bottles, which means they do not need to pay the manufacturers surcharge to access these products.

The current list of clinical situations that enable people to receive an additional subsidy is available on the Pharmac website:

• People being bolus fed through a feeding tube,
• people who have severe epidermolysis bullosa,
• as exclusive enteral nutrition in children under the age of 18 years for the treatment of Crohn's disease, or
• for people with COPD and hypercapnia, defined as CO2 value exceeding 55mmHg

The Special Authority linked to from the Schedule listing has more details(external link)

Oral feed 1.5kcal/ml, 200 ml bottles are fully funded for eligible people in Health New Zealand | Te Whatu Ora Hospitals and additional surcharges do not need to be paid to receive them. No changes have been proposed to hospital funding arrangements.

Why we’re proposing this

In 2021, Pharmac received a funding application for oral feed 1.5kcal/ml for adults with Crohn’s disease for use as EEN. 

Application for Oral feed 1.5kcal/mL | Application Tracker(external link)

Clinical advice on this application was received from the Special Foods Advisory Committee at its meeting in October 2023. The Committee recommended that standard supplements should be fully funded for adults with Crohn’s disease with a high priority. 

Meeting record for the Special Foods Advisory Committee meeting (October 2023) [PDF, 592 KB]

The Committee noted that people following an EEN diet receive all their required daily calories, macro and micronutrients from liquid supplements and EEN could be used by people with inflammatory bowel disease (IBD) to reduce inflammation, provide a bridge to pharmacological treatment, and assist with the management of fistula or abscess.

The Committee acknowledged that people with Crohn’s disease have access to fully funded 1kcal/ml oral feed powder but noted that this is not an appropriate product for EEN due to the fibre content.

The Committee noted that standard supplements are currently fully funded for people under 18 years of age requiring EEN for the management of Crohn’s disease, and this proposal would mean that full funding of standard supplements for people requiring EEN for the management of Crohn’s disease would be extended to adults.

The Committee considered that the funding of standard supplements for EEN in adults with Crohn’s disease could result in increased time in remission compared with corticosteroids, and possible reductions in the need for surgery and associated side effects.

This proposal follows a decision by Abbott to discontinue its Ensure Plus HN cans and would mean that adults with Crohn’s disease requiring EEN continue to have a clinically appropriate fully funded option available to them.

Pharmac has open funding applications for full funding of 1.5kcal/ml bottles for other groups, including:

• People with head and neck cancer(external link), which is currently ranked on Pharmac’s Options for Investment list. 

• People with Chronic Obstructive Pulmonary Disease (COPD) with malnutrition(external link), which is currently under assessment with Pharmac’s Health Economics Team. 

Both of these proposals will continue to be considered through Pharmac’s assessment and funding process.

Details about our proposal

This proposal would mean that from 1 July 2025 the endorsement criteria for full funding of standard supplements in the community would be updated as follows to include adults with Crohn’s disease requiring EEN (deletions in strikethrough).

It is estimated that up to a maximum of 200 adults with Crohn’s disease may be initiated on an EEN diet each year in New Zealand and would remain on an EEN diet for up to a maximum of 12 weeks.

To provide feedback

Send us an email: Consult@Pharmac.govt.nz by 5:00pm, Wednesday, 4 June 2025.

All feedback received before the closing date will be considered by Pharmac’s Board (or its delegate) prior to making a decision on this proposal.

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