ALEXANDRIA, Virginia—The National Home Infusion Association (NHIA) has released a white paper examining the economic challenges facing home parenteral nutrition (HPN) services. The report, “Ensuring Sustainable Access to Home Parenteral Nutrition (PN): The Cost Crisis and Path Forward,” documents cost trends and reimbursement patterns affecting this therapy.
Cost and Reimbursement Trends
The paper states that home parenteral nutrition serves approximately 32,000 Americans annually who cannot absorb nutrients through their gastrointestinal tract due to medical conditions. While HPN reduces health care costs by 32-36% compared to hospital-based care, providers face increasing economic pressures.
NHIA’s analysis shows that costs to prepare HPN rose by a compounded 75.4% from 2016 to 2024, while average reimbursement for PN services (inclusive of nursing and non-compounded drugs), declined from 2022 to 2024. This gap between expenses and reimbursement has contributed to a 15.6% average annual decrease in the number of home infusion pharmacies submitting HPN claims over the past three years.
Contributing Factors
The white paper identifies several factors affecting HPN economics:
- Supply chain issues: Seventeen of the 24 ingredients used to compound HPN have appeared on shortage lists in the past two years
- Regulatory changes: The FDA’s Unapproved Drug Initiative led to price increases for certain components, including IV selenium, which increased from $2.13 to $23.25 per day for a typical patient
- Operating costs: Labor costs rose 21.1% from February 2020 to February 2024, while USP <797> sterile compounding requirements require investments in facilities and training
- Service requirements: Pharmacists spend an average of 42 minutes per HPN patient daily, excluding time from nurses, dietitians and other team members.
Recommendations
NHIA’s white paper proposes immediate and long-term strategies to address these challenges. Near-term recommendations include adjusting payment rates to reflect current costs and considering alternative coding methodologies. Long-term solutions involve exploring value-based payment models that balance quality outcomes with provider sustainability.
The report notes that some states have begun addressing these issues, with Colorado recently passing legislation to increase Medicaid payment for HPN administrative services. NHIA encourages stakeholders to review the analysis and consider similar approaches to maintain access to this therapy.
To view the white paper, visit nhia.org.