NHIA White Paper: The Cost Crisis in Home Parenteral Nutrition

Supporting 32,000 patients annually(1), Home Parenteral Nutrition (HPN) is a lifeline for individuals with severe gastrointestinal issues, allowing them to receive essential nutrients intravenously outside of the hospital. This increased flexibility allows most HPN patients to lead active lives outside of a care facility, while also contributing to improved outcomes, reduced hospitalizations, and lower overall healthcare costs. While the clinical benefits of HPN are well-documented, the infrastructure supporting this therapy is under serious threat.

In a recently released whitepaper by the National Home Infusion Association (NHIA), a stark economic reality is revealed. NHIA’s white paper, titled “Ensuring sustainable Access to Home Parenteral Nutrition (PN): The Cost Crisis and Path Forward,” looked at data collected from 20 unique home infusion pharmacies from 2016-2024, including the direct cost of HPN ingredients for nearly 1 million bags of PN. It was determined that the cost of delivering HPN has surged by 75.4% since 2016.(1,2). In addition, the whitepaper found that an analysis of claims data from 2022-2024, which include commercial, Medicare, and Medicaid claims, showed that the total monthly reimbursement payment for a patient(2) on HPN had decreased by 5.47%.(1) This growing gap seems to be forcing providers out of the market and putting patient access at risk.

What can be done?

HPN is not a plug-and-play therapy. It requires coordinated care from pharmacists, nurses, and dietitians, often with weekly oversight. Yet, many of these services go unreimbursed.

The bottom line is that without immediate and coordinated action, the home HPN ecosystem will continue to erode, leaving patients with fewer options, longer hospital stays, and higher costs for the system. The data is clear: HPN is clinically effective and cost-saving,(3,4,5,6) but only if providers are supported with sustainable reimbursement and policy frameworks.

To that end, NHIA has recommended a number of both short and long-term strategies which are outlined below:

Short-Term Strategies

• Recognize true costs: Payors must acknowledge the real-world cost of providing HPN and adjust payment rates accordingly.
• Adjust reimbursement models: Consider alternative coding methods to allow separate billing of PN drugs and components (e.g., using NDC or HCPCS codes like B-codes for nutrients).
• Un-bundle drug payments: Move away from bundled per diem models to reflect actual drug acquisition costs.
• Ensure provider access: Maintain adequate in-network participation of qualified pharmacies capable of same-day nursing and delivery services to prevent ER visits and therapy interruptions.

Long-Term Strategies

• Implement value-based care models: Develop payment structures that reward improved outcomes, better transitions of care, and reduced hospitalizations.
• Reassess restrictive policies: Review payor policies that inadvertently increase costs, such as limits on nursing visits or high co-pays for catheter maintenance.
• Support legislative solutions: Encourage state-level legislation that incentivizes investment in PN infrastructure and staff training.
  • Example: Colorado’s Senate Bill 25-084 increased Medicaid reimbursement for HPN pharmacy services to address provider drop-off(7).
• Expand Medicaid access: States should evaluate whether Medicaid patients have sufficient access to HPN services.

Home Parenteral Nutrition is not just about nutrition, it’s a life-sustaining therapy that allows patients to live fuller, more active lives. Yet, despite its proven clinical and economic value, the sustainability of HPN is at a tipping point. NHIA’s whitepaper makes it clear: rising costs, stagnant reimbursement, and systemic barriers are threatening access for thousands of vulnerable patients.

The path forward requires collaboration. Payors must recognize the true cost of care. Policymakers must support infrastructure and access. And providers must be empowered with fair, flexible reimbursement models that reflect the complexity and value of the services they deliver.

To learn more about Home Parenteral Nutrition and other infusion related topics, and to engage with others in the infusion community, visit the NHIA Community at https://community.nhia.org/home. 

1. Trella Health, claims data on file
2. NHIA. Impact of Pandemic-Related Drug and Supply Shortages on the Home and Alternate Site Infusion Industry, INFUSION, Jan/Feb 2023; pages 34-36.
3. Girke J, Seipt C, Markowski A, et al. Quality of Life and Nutrition Condition of Patients Improve Under Home Parenteral Nutrition: An Exploratory Study. Nutr Clin Pract. 2016;31(5):659-665. doi:10.1177/0884533616637949in Pract. Published online April 25, 2025. doi:10.1002/ncp.11301
4. Martinuzzi A, Crivelli A, Flores A, et al. Cost savings of home parenteral nutrition compared with hospital parenteral nutrition: A multicenter prospective analysis. Nutr Cl Pract. 2016;31(5):659-665. doi:10.1177/0884533616637949in Pract. Published online April 25, 2025. doi:10.1002/ncp.11301
5. Brard L, Weitzen S, Strubel-Lagan SL, et al. The effect of total parenteral nutrition on the survival of terminally ill ovarian cancer patients. Gynecol Oncol. 2006;103(1):176-180. doi:10.1016/j. ygyno.2006.02.013
6. Sowerbutts AM, Lal S, Sremanakova J, et al. Palliative home parenteral nutrition in patients with ovarian cancer and malignant bowel obstruction: experiences of women and family caregivers. BMC Palliat Care. 2019;18(1):120. Published 2019 Dec 29. doi:10.1186/s12904-019- 0507-5e