Decision to fully fund liquid supplements in the community for adults with Crohn’s disease requiring exclusive enteral nutrition (EEN)

Medicines Decision

What we’re doing

We’re fully funding oral feed 1.5kcal/ml bottles for adults with Crohn’s disease requiring exclusive enteral nutrition (EEN) in the community from 1 July 2025.

This group of people previously had a fully funded option available to them, Ensure Plus HN cans. However, these products were discontinued by the supplier.

The current alternative product is oral feed 1.5kcal/ml bottles (branded as Ensure Plus and Fortisip) however these products have had a part charge. This decision will remove the part charge for this group of people.

We anticipate that up to 200 adults per year could access fully funded oral feed 1.5kcal/ml bottles for EEN for the management of their Crohn’s disease.

Why we’re proposing this

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

This decision follows the discontinuation of Ensure Plus HN cans which were previously supplied by Abbott and would mean that adults with Crohn’s disease requiring EEN continue to have a clinically appropriate fully funded option available to them.

Clinical advice about this decision

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 requiring EEN with a high priority.

Record of the October 2023 meeting of the Special Foods Advisory Committee [PDF, 592 KB]

The Committee noted that an EEN diet provides all required daily calories, macro and micronutrients, from liquid supplements. EEN can be used by people with inflammatory bowel disease (IBD) to reduce inflammation, provide a bridge to pharmacological treatment, and assist with the management of fistulas or abscesses. It also considered the use of these supplements as ENN could result in increased time in remission compared with corticosteroids, and potential reductions in the need for surgery and associated side effects.

The Committee acknowledged that people with Crohn’s disease have access to fully funded 1kcal/ml oral feed powder but noted it is unsuitable for EEN due to the fibre content.

The Committee noted currently, the supplements are fully funded for people under 18 requiring EEN for Crohn’s disease. This proposal would extend full funding of standard supplements to adults requiring EEN for Crohn’s disease.

Clinical advice about other funding applications

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

These proposals will continue to be considered through Pharmac’s assessment and funding process.

Any changes to the original proposal?

This decision was subject to a consultation letter dated 20 May 2025. All of the feedback we received was supportive of this proposal being progressed.

We heard from people with Crohn’s disease who have used an EEN diet to help manage their Crohn’s disease in the past and people who would appreciate having this option in the future. We also received feedback from family members of people living with Crohn’s disease, dietitians and clinicians who treat people with Crohn’s disease, medical Colleges, and other groups of people involved in the health care of people living Crohn’s disease.

We are grateful to the people who took the time to respond to our consultation. Receiving feedback is an important part of our decision-making process and helps to ensure that the proposal is likely to benefit the identified population in the manner intended.

After carefully considering feedback, we have not made any changes to the proposal following the consultation

Who we think will be most 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

Detail about this decision

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

Higher subsidy by endorsement – Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube, who have severe epidermolysis bullosa, or as exclusive enteral nutrition in children under the age of 18 years for the treatment of Crohn’s disease, or for patients with COPD and hypercapnia, defined as CO2 value exceeding 55mmHg. The prescription must be endorsed accordingly.

It is estimated that up to 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 12 weeks.

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, that can affect any part of the gut lining. People living with Crohn’s disease have a range of relapsing and remitting symptoms unique to their experience which include pain, weight loss, changes in bowel habit, bleeding, fatigue and others. In many cases people experience complications of their condition, such as abscesses and fistulae.  

Periods of relapse are typically treated with therapies such as immunosuppressants and glucocorticoids, followed by advanced treatments such as anti-TNF (tumour necrosis factor) 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, fats, protein, vitamins, and minerals. For people with Crohn’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.

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.

Groups eligible for full funding

People with particular health conditions are eligible for funded products which means they do not pay a part charge. These groups (included on the Pharmaceutical Schedule(external link)) have not changed as part of this decision and include:

  • 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

Oral feed 1.5kcal/ml, 200 ml bottles are fully funded for eligible people in Health New Zealand | Te Whatu Ora Hospitals.

Our response to what you told us

We’re really grateful for the time people took to respond to this consultation. A summary of the main themes raised in feedback, our responses to the feedback received, and changes we have made after listening to you are provided below. 

Theme

Pharmac response

General support for proposal

All responses received were supportive of the proposal.

Many respondents shared their personal experiences with Crohn’s disease and highlighted their previous positive experiences using exclusive enteral nutrition as a treatment option.

Clinicians involved in the care of people with Crohn’s disease, including dietitians also voiced their support for the proposal and acknowledged the benefit they considered an EEN diet offers for the people they care for.

We are pleased to be progressing a proposal which is supported by people living with Crohn’s disease, their family and whānau and clinicians. This proposal would provide more treatment options for people living with Crohn’s disease. 

Support for full funding

Respondents including people with Crohn’s disease and their clinicians shared the impact the current partial funding for oral feed 1.5 kcal/ml 200 ml bottles was having for them. Including placing them under additional financial pressure at times when they may be unable to work because of their Crohn’s disease.

Clinicians also noted that the current part funding arrangements meant some people were unable to complete a course of EEN because of the cost, and it was also a barrier to them recommending the diet in some instances.

Respondents also noted that the currently available fully funded oral feed powder was not suitable for an EEN diet.

We appreciate the feedback that the full funding of oral feed 1.5 kcal/ml 200 ml bottles will provide an additional treatment option for adults with Crohn’s disease and may have less side effects than other available options such as corticosteroids.

We understand that due to the large volume of supplement that may need to be consumed as part of an EEN diet the financial burden can be significant.

We have heard that the currently available fully funded oral feed powders are not suitable for an EEN diet and are pleased that adults with Crohn’s disease requiring an EEN diet will continue to have fully funded options available to them following the discontinuation of Ensure Plus HN Cans.

Requests for plant-based supplements to be funded

Clinicians who treat people with Crohn’s disease requested access to plant-based liquid supplements when these become available.  These would be suitable for people who have cow’s milk allergy or are vegan and cannot easily access a funded EEN diet.

It was noted that as funded soy-based supplements had not been available for a number of years these people were using elemental feed such as 028 elemental in some instances. However, this was not suitable for their needs due to the low protein content

We appreciate that plant-based special foods would offer benefits to people who require nutritional supplements but are unable to consume ones that contain dairy products.

We have recently received an application for plant based Fortisip.

We intend to seek clinical advice on this proposal from the Special Foods Advisory Committee in future.

Requests for biologic medicines to be funded for children with Crohn’s disease

A request was received for Pharmac to consider funding biologic medicines for children with Crohn’s disease who need them without requiring them to first trial azathioprine.

We have received funding applications for access to adalimumab and infliximab for children with Crohn’s disease who have required a course of exclusive enteral nutrition EEN, which are currently under assessment. More information about the status of these applications is available on our website.

Adalimumab(external link)

Infliximab(external link)

 

If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz; or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 660 050.