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

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):

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.