Medical experts have raised concerns that current support policies for enteral nutrition -- an essential therapy for pediatric and adolescent patients with Crohn’s disease -- do not reflect clinical needs.
Enteral nutrition involves delivering specially formulated nutrients directly to the digestive tract, either orally or via feeding tube. For children, whose growth and development are critical, it is widely recommended as a first-line therapy, helping reduce drug-related side effects, improve nutritional status, and control intestinal inflammation.
The Pediatric IBD Research Group under the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition said Wednesday that it submitted a proposal to the Ministry of Health and Welfare, calling for reforms to what it described as structural limitations in the current system.
‘How can treatment have a one-year limit?’
At present, pediatric Crohn’s disease patients in Korea receive full government support for eight weeks of exclusive enteral nutrition (EEN), followed by partial enteral nutrition (PEN) support for up to one year. However, the policy requires support to end after one year, regardless of medical condition.
The society emphasized that Crohn’s disease is a lifelong inflammatory condition requiring continuous management. “There is no medical evidence to justify limiting nutritional therapy for maintaining remission to one year,” the group said, questioning the basis of the cap.
According to the society, patients who lose eligibility must pay out of pocket, with monthly costs ranging from 200,000 won ($135) to over 800,000 won ($540).
Proposed reforms balance misuse prevention and access
To address both budget constraints and concerns about misuse—such as product sharing or resale -- the society proposed several policy changes.
Key recommendations include removing the fixed one-year limit, introducing a co-payment system, and expanding the quantity of supported products.
Under the proposal, the current system would remain unchanged during the first year, with patients receiving one to two packs per day free of charge after the initial eight-week EEN period. After one year, patients would continue receiving support through a co-payment model, contingent on certification from a pediatric gastroenterology specialist.
The society also called for lifting quantity restrictions, arguing that patients requiring higher doses should be eligible for increased support to achieve meaningful clinical outcomes.
A representative said, “Introducing co-payments would ensure that only patients who truly need the products receive them, thereby preventing misuse such as sharing or resale. Reduced waste would allow expanded support for patients in genuine need.”
The group added that co-payment rates and monthly caps could be adjusted based on budget conditions.
Concerns over access and administrative burden
The society also pointed to inefficiencies in the current distribution system, which relies on public health centers and involves complex paperwork. Patients must reapply every three months, often facing delays. Standardized allocation that does not account for patient preferences has also been cited as reducing adherence.
As part of its recommendations, the society proposed simplifying documentation requirements and diversifying distribution channels, including direct ordering through manufacturers.
“The proposal represents a practical approach to support children’s growth and improve long-term outcomes while minimizing the government’s financial burden,” the society said, urging policymakers to revise the current system.
You Ji-young
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