Formulary Guide - Apria

Apria Is Your Resource for Expert Home Enteral Nutrition Support Refresh Home Nutrition Support Program is a service of Apria Healthcare. ©2018 Apria Healthcare Group Inc. ENT-4050 Rev. 09/18 Apria Healthcare LLC compli…
Disclaimers: All formula substitutions require clinical judgment; please contact a clinician for appropriateness of alternative options.
Formulary Guide

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Formulary Guide

RefreshTM Formulary Guide

This guide provides a list of the nutrients included in the Nestl� Health Science formulary products. Use this table as a general guideline for product replacement only. Actual product replacement requires a comparative product evaluation and clinical judgment. Patients should consult their clinicians regarding the use of tube feeding products and any concerns they may have.

Tube Feeding

Nestl� Health
Science Product Name

Nutren� 1.0

Nutren� 1.0 Fiber

Intact Protein

Isosource� HN Fibersource� Nutren� 1.5 Isosource�

HN

1.5 Cal

Nutren� 2.0 Nutren Junior� Nutren Junior� Replete� Fiber

HCPCS

B4150

B4150

B4150

B4150

B4152

B4152

B4152

B4160

B4160

B4150

Description

Complete nutrition

Complete nutrition with ber

High nitrogen, High nitrogen Calorically complete complete dense, nutrition nutrition complete
with ber nutrition

Calorically Calorically

dense, complete dense,

nutrition with complete

ber

nutrition

Complete liquid Complete liquid nutrition nutrition

Very high protein, complete nutrition

Calories per mL 1.0

1.0

1.2

1.2

1.5

1.5

2.0

1.0

1.0

1.0

Protein (g)

40

40

54

54

68

68

84

30

30

64

Protein (% of kcal) 16%

16%

18%

18%

18%

18%

16%

12%

12%

25%

Carbohydrate (g) 136

148

156

164

176

176

216

110

110

112

Carbohydrate 54%

54%

53%

53%

47%

47%

43%

44%

44%

45%

(% of kcal)

Fat (g)

34

34

40

40

60

59.2

92

49.6

49.6

34

Fat (% of kcal) 30%

30%

29%

29%

35%

35%

41%

44%

44%

30%

Fiber (g)

N/A

15.2

N/A

15.2

N/A

15.2

N/A

N/A

6

N/A

Water (%)

85%

83%

81%

81%

76%

76%

69%

85%

85%

84%

Sodium (mg)

880

880

1120

1120

1300

1300

1500

460

460

880

Potassium (mg) 1600

1600

1920

1920

2400

2400

2100

1320

1320

1600

Phosphorus (mg) 800

800

960

960

1200

1200

1480

840

840

800

Calcium (mg) 800

800

960

960

1200

1200

1600

1200

1200

800

Osmolality

330

340

510

480

530

650

780

350

350

300

(mOsm/kg)

Meet or exceed 1500

1500

1250

1250

1000

1000

750

100% RDI/DRI (mL)

1-8 years 1-8 years

1500

1000 mL, 9-13 1000 mL, 9-13

years 1500 mL years 1500 mL

Alternate to
Abbott Nutrition Product Name

Osmolite� 1 Cal

Jevity� 1 Cal Osmolite� 1.2 Cal

Jevity� 1.2 Cal Osmolite� 1.5 Cal

Jevity� 1.5 Cal TwoCal� HN

PediaSure� PediaSure� Promote�

Enteral Formula Enteral Formula

1.0 Cal

1.0 Cal with Fiber

 Registered trademarks of Soci�t� des Produits Nestl� S.A., Vevey, Switzerland. * Except for vitamin A, chloride, phosphorus, and magnesium pertains to Novasource Renal and meet or exceed 100% RDI/DRI (mL).  Registered trademarks of Abbott Laboratories.
Disclaimers: All formula substitutions require clinical judgment; please contact a clinician for appropriateness of alternative options. Not all clinical considerations are included and the listed alternatives may not be nutritionally comparable or equivalent in all respects. All product information is obtained from product literature as available upon the date of issue and is subject to change. For speci c nutritional information, please consult the manufacturer. For assistance in Nestl� product selection and clinical application, call Nestl� at 1-800-422-ASK2 (2752). In addition, please note the following: PEPTAMEN� formulas contain milk protein and therefore may not be appropriate for individuals who have an allergy to cow's milk protein.

per 1000 mL

Replete� Fiber

Condition Speci c

Glytrol�

Diabetisource� Nutren�

AC

Pulmonary

B4150

B4154

B4154

Very high

Complete

protein, complete nutrition for

nutrition

patients with

with ber

hyperglycemia

Advanced control tube feeding

1.0

1.0

1.2

64

45.2

60

25%

18%

20%

124

100

100

45%

40%

36%

B4154 Complete liquid nutrition
1.5 68 18% 100 26%

Novasource� Renal
B4154 Nutritionally complete formula
2.0 90.7 18% 183 37%

Peptide-Based

Peptamen� Peptamen� Peptamen AF� with PrebioTM

Peptamen� 1.5 Peptamen Junior� with PrebioTM

Peptamen Junior� 1.5

B4153

B4153

B4153

B4153

B4161

B4161

Complete, Complete, Complete, peptidepeptide-based peptide-based based nutrition nutrition nutrition with EPA, DHA, and
PrebioTM soluble ber

Complete, Complete, calorically peptide-based dense, peptide- formula based nutrition

Complete, peptide-based formula

1.0

1.0

1.2

1.5

1.0

1.5

40

40

76

68

30

45

16%

16%

25%

18%

12%

12%

128

128

112

188

136

180

51%

49%

35%

49%

54%

48%

34

47.6

58.8

94.8

100

39

40

54

30%

42%

44%

56%

45%

33%

35%

40%

15.2

15.2

15.2

N/A

N/A

N/A

4

6

83%

84%

82%

78%

72%

85%

84%

81%

880

740

1060

1168

945

560

560

800

1600

1400

1600

1872

945

1500

1500

1600

800

720

800

1200

819

700

700

800

800

720

800

1200

840

800

800

800

330

280

450

330 - 450 800

270

300

390

56

38.4

68

33%

34%

40%

N/A

3.6

5.6

77%

84%

77%

1040

460

692

1880

1320

1980

1000

840

1352

1000

1120

1650

550

390 - 435 450

1500
Promote� with Fiber

1500
Glucerna� 1.0 Cal

1250

1000

1000*

1500

1500

1250

Glucerna� Pulmocare� Nepro� with Vital� 1.0 Cal Vital� 1.0 Cal Vital� AF 1.2 Cal

1.2 Cal

Carb SteadyTM

1000 Vital� 1.5 Cal

1-8 years 1-8 years 1000 mL, 9-13 750 mL, 9-13 years 1500 mL years 1000 mL
PediaSure� PediaSure� Peptide 1.0 Cal Peptide 1.5 Cal

� 2016 Nestl�. Reprinted with permission. Except where noted, all trademarks are owned by Soci�t� des Produits Nestl� S.A., Vevey, Switzerland.

Apria Is Your Resource for Expert Home Enteral Nutrition Support

America's leading provider of home healthcare products and services is also a leader in home enteral nutrition support.
For New Enteral Patient Referrals Call one of our Nutrition Support Specialists at Continental U.S. (844) 260-1788 | Hawaii (800) 454-5672
Or fax your order to (844) 281-1309 See program details at apria.com/Refresh

Ordering Enteral Nutrition
To help ensure a complete and accurate order is received, please specify the following information on the order:
� Route of administration (NG, NJ, GT, or JT) � Formula name (brand name) � Formula volume total per day (mL or cartons/day) � Formula calorie total per day (kcal/day) � Method of administration (bolus, gravity, or pump)
� For bolus or gravity: volume per feeding (mL or cartons) and # feedings per day
� For pump: rate (mL/hour) and # hours per day � Water ush total per day (mL/day) and volume
per frequency � Indicate home replacement supplies, if applicable
(extension sets or feeding tube replacement)

Apria's Commitment to Satisfaction
Apria's patient- rst approach helps to ensure the optimal health, comfort, and quality of life of each patient throughout the duration of home enteral nutrition therapy.
Focused on Positive Clinical Outcomes
As part of the RefreshTM Program, Apria's licensed Nutrition Support Dietitians are available to perform nutritional assessments and make home tube feeding recommendations.
Our Nutrition Support Dietitians utilize evidence-based assessment tools to identify and manage malnutrition risks and work with the patient's healthcare provider to adjust therapy, as required.

Apria Healthcare LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Apria Healthcare LLC cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Apria Healthcare LLC 
Refresh Home Nutrition Support Program is a service of Apria Healthcare. �2018 Apria Healthcare Group Inc.

ENT-4050 Rev. 09/18