Decision to fund enteral liquid peptide formulas (Nutrini Peptisorb and Nutrini Peptisorb Energy)

Source: Pharmac

What we’re doing

Nutrini Peptisorb and Nutrini Peptisorb Energy are nutritionally complete liquid peptide (semi-elemental) enteral feeds, designed for children with impaired GI function such as maldigestion or malabsorption, who do not tolerate a polymeric feed or for whom a polymeric feed may not be suitable. Both Nutrini Peptisorb and Nutrini Peptisorb Energy can be administered via naso-enteric tube, gastrostomy or jejunostomy.

We estimate that approximately 12 children per year will benefit from the listing of Nutrini Peptisorb and Nutrini Peptisorb Energy.

Any changes to the original proposal?

This decision was subject to a consultation letter dated 21 July 2020.

No changes were made to the proposal following consultation feedback.

Who we think will be most interested

• Parents and whānau of children with impaired GI function
• Community and hospital dietitians
• Paediatricians, paediatric gastroenterologists, paediatric surgeons, general practitioners, pharmacists and other clinicians and health professionals involved in the management of children with impaired GI function
• Pharmaceutical suppliers and wholesalers

Detail about this decision

Nutrini Peptisorb and Nutrini Peptisorb Energy will be listed in Section D of the Pharmaceutical Schedule from 1 September 2020 at the following prices and subsidies (ex-manufacturer, excluding GST):

Chemical	Formulation	Brand	Pack size	Proposed price
Enteral liquid peptide formula	Liquid 1kcal/ml	Nutrini Peptisorb	500 ml OP	$10.45
Enteral liquid peptide formula	Liquid 1.5kcal/ml	Nutrini Peptisorb Energy	500 ml OP	$15.68

The following Special Authority criteria will apply:

Special Authority for Subsidy

Initial application – only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria:

All of the following:

1. Patient has impaired gastrointestinal function and either cannot tolerate polymeric feeds, or polymeric feeds are unsuitable; and
2. Any of the following:

2.1 Severe malabsorption; or

2.2 Short bowel syndrome; or

2.3 Intractable diarrhoea; or

2.4 Biliary atresia; or

2.5 Cholestatic liver diseases causing malabsorption; or

2.6 Cystic fibrosis; or

2.7 Proven fat malabsorption; or

2.8 Severe intestinal motility disorders causing significant malabsorption; or

2.9 Intestinal failure; or

2.10 Both:

2.10.1 The patient is currently receiving funded amino acid formula; and

2.10.2 The patient is to be trialled on, or transitioned to, an enteral liquid peptide formula; and

3. Either:

3.1 A semi-elemental or partially hydrolysed powdered feed has been reasonably trialled and considered unsuitable; or

3.2 For step down from intravenous nutrition.

Note: A reasonable trial is defined as a 2-4 week trial.

Renewal – only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria:

All of the following:

1. An assessment as to whether the patient can be transitioned to a cow’s milk protein or soy infant formula or extensively hydrolysed formula has been undertaken; and

2. The outcome of the assessment is that the patient continues to require an enteral liquid peptide formula; and

3. General practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and the date contacted.

Nutrini Peptisorb and Nutrini Peptisorb Energy will be listed in Part II of Section H of the Pharmaceutical Schedule from 1 September 2020 at the following prices and subsidies (ex-manufacturer, excluding GST):

Chemical	Formulation	Brand	Pack size	Proposed price
Enteral liquid peptide formula	Liquid 2.75 g protein, 13.7 g carbohydrate and 3.89 g fat per 100 ml	Nutrini Peptisorb	500 ml OP	$10.45
Enteral liquid peptide formula	Liquid 4.2 g protein, 18.6 g carbohydrate and 6.58 g fat per 100 ml	Nutrini Peptisorb Energy	500 ml OP	$15.68

The following Hospital restrictions will apply:

Restricted

Initiation –

All of the following:

1. Patient has impaired gastrointestinal function and either cannot tolerate polymeric feeds, or polymeric feeds are unsuitable; and
2. Any of the following:

2.1 Severe malabsorption; or

2.2 Short bowel syndrome; or

2.3 Intractable diarrhoea; or

2.4 Biliary atresia; or

2.5 Cholestatic liver diseases causing malabsorption; or

2.6 Cystic fibrosis; or

2.7 Proven fat malabsorption; or

2.8 Severe intestinal motility disorders causing significant malabsorption; or

2.9 Intestinal failure; or

2.10 Both:

2.10.1 The patient is currently receiving funded amino acid formula; and

2.10.2 The patient is to be trialled on, or transitioned to, an enteral liquid peptide formula; and

3. Either:

3.1 A semi-elemental or partially hydrolysed powdered feed has been reasonably trialled and considered unsuitable; or

3.2 For step down from intravenous nutrition.

Note: A reasonable trial is defined as a 2-4 week trial.

Continuation –

Both:

1. An assessment as to whether the patient can be transitioned to a cows milk protein or soy infant formula or extensively hydrolysed formula has been undertaken; and
2. The outcome of the assessment is that the patient continues to require an enteral liquid peptide formula. 

Our response to what you told us

We’re really grateful for the time people took to respond to this consultation. All responses received were supportive of the proposal.

There was a concern raised that the currently available powdered feeds used by children with impaired GI are essential to retain listed on the Pharmaceutical Schedule.  We note that access and supply of these products are unchanged as a result of this decision. 

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 66 00 50.

MIL OSI