The infrastructure that keeps tens of thousands of Americans fed at home through tube feeding and IV nutrition is under mounting financial strain, according to industry data from the National Home Infusion Association (NHIA). The compounded cost of preparing home parenteral nutrition (HPN) rose 75.4% between 2016 and 2024, even as average reimbursement for the therapy declined between 2022 and 2024.
Home parenteral nutrition serves an estimated 32,000 Americans annually, delivering nutrients intravenously to patients whose digestive systems cannot process food normally. It is typically far less expensive than an extended hospital stay, but the economics for the pharmacies and home infusion companies that provide it have deteriorated. NHIA data shows the number of home infusion pharmacies offering HPN services has fallen by an average of 15.6% per year over the past three years.
Several forces are converging. Supply chains for HPN components remain fragile: 17 of the 24 ingredients used in parenteral nutrition formulations have appeared on shortage lists within the past two years. Regulatory shifts, including the FDA’s Unapproved Drug Initiative, have also pushed up prices for some components. On the labor side, pharmacists spend an average of 42 minutes per patient per day managing HPN cases — a workload that adds cost without a matching increase in payment.
The National Home Infusion Association reports a 75.4% compounded increase in HPN preparation costs from 2016 to 2024, while average reimbursement declined between 2022 and 2024.
Home enteral nutrition (HEN) — tube feeding delivered through the gut rather than a vein — faces a related but distinct problem. An estimated 220,000 people in the U.S. rely on HEN, but the post-acute clinical services that support them are largely unreimbursed. Medicare’s Durable Medical Equipment Competitive Bidding Program has pushed down payment rates for feeding pumps, formula, and supplies, which industry data links to a decline in the number of Medicare-participating HEN suppliers and beneficiaries served.
For registered dietitians and other clinicians who coordinate home nutrition support, the practical effect is a shrinking pool of infusion pharmacies and DME suppliers willing or able to take on new HPN and HEN patients — particularly in regions that were already underserved. Patients being discharged onto home nutrition support may face longer waits to find a provider, and clinicians may need to plan referrals earlier and confirm supplier capacity before discharge rather than after.
The pressure comes even as the broader homecare clinical nutrition market keeps growing — projected to reach $7.23 billion in the U.S. by 2026, driven by an aging population and a steady shift of complex care out of hospitals and into the home. That growth in demand, paired with shrinking reimbursement and a thinning supplier base, is the tension industry groups like NHIA and the American Society for Parenteral and Enteral Nutrition (ASPEN) are now pressing regulators to address.
The Academy of Nutrition and Dietetics, which represents more than 112,000 credentialed practitioners, has continued to push its “A Seat at Every Table” initiative advocating for dietitians’ role in nutrition-related policy decisions — a role that home nutrition support advocates say is increasingly relevant as reimbursement policy, not clinical need, becomes the limiting factor in who can access this care.