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<span>MODULEN®</span>

MODULEN®

Modulen™ is a nutritionally complete formula for the special dietary use of children (age 5+), adolescents and adults with Crohn’s disease who choose to follow an enteral diet as either a sole or partial source of nutrition under medical supervision. Meets criteria for partial enteral nutrition as part of the Crohn’s Disease Exclusion Diet (CDED)1.

1. Levine A, et al. Gastroenterology 2019;157:440-450

Letter of Medical Necessity

MODULEN®

Modulen™ is a nutritionally complete formula for the special dietary use of children (age 5+), adolescents and adults with Crohn’s disease who choose to follow an enteral diet as either a sole or partial source of nutrition under medical supervision. Meets criteria for partial enteral nutrition as part of the Crohn’s Disease Exclusion Diet (CDED)1.

1. Levine A, et al. Gastroenterology 2019;157:440-450

Letter of Medical Necessity

Key Benefits

  • Modulen™ is a nutritionally complete formula for the special dietary use of individuals with Crohn’s disease who choose to follow an enteral diet as either a sole or partial source of nutrition under medical supervision.
  • Meets criteria for partial enteral nutrition as part of the Crohn’s Disease Exclusion Diet (CDED)1.
  • Specifically designed for use in children (age 5+), adolescents and adults with Crohn’s disease.
  • Free From: Artificial sweeteners, Artificial flavors, and Artificial colors

Notes & Disclaimers for Key Benefits (Healthcare Professionals)

  • 1. Levine A, et al. Gastroenterology 2019;157:440-450.

Nutrition Facts

Nutritional Features

Modulen®
kcal/mL 1.0
Caloric Distribution Protein (% of kcal)
 		Protein 13%
Carbohydrate 47%
Fat 40%
L-Arginine (g)
L-Glutamine (g)
Sodium (mEq) 5
Calcium (mEq) 15
Potassium (mEq) 10
Chloride (mEq) 8
NPC:N Ratio 163:1
MCT:LCT Ratio 28:72
n6:n3 Ratio 21:1
Free Water (%) 84
Dietary Nucleotides (g)
EPA + DHA (g)
Source of Oil
Osmolality (mOsm/kg water) 415
Density (g/mL)
Renal Solute Load (mOsm/L)
mL to Meet 100% DRI
ARA (mg)

Nutritional Applications

  • Use under medical supervision as part of an exclusive enteral nutrition or partial enteral nutrition diet for indivdiuals with Crohn’s disease
  • Meets criteria for partial enteral nutrition as part of the Crohn’s Disease Exclusion Diet

Important Notes:

NOT FOR PARENTERAL USE
ONLY SUITABLE FOR AGES 5 YEARS AND OLDER.

Suitable for the following diets

  • Lactose intolerance*
  • Gluten free
  • Halal

Important Notes:

*Not for individuals with galactosemia

Protein Source

  • Acid Casein (Milk)

Fat Source

  • Milkfat
  • Medium Chain Triglycerides
  • Corn Oil

Carbohydrate Source

  • Glucose Syrup
  • Sugar

Ingredients

GLUCOSE SYRUP, ACID CASEIN (MILK), SUGAR, MILKFAT, MEDIUM CHAIN TRIGLYCERIDES, CORN OIL, AND LESS THAN 2% OF CALCIUM CITRATE, SOY LECITHIN, SODIUM PHOSPHATE, MAGNESIUM CHLORIDE, CALCIUM PHOSPHATE, POTASSIUM CHLORIDE, CHOLINE BITARTRATE, SODIUM CITRATE, SODIUM ASCORBATE, CITRIC ACID, FERROUS SULFATE, ZINC SULFATE, DL-ALPHA TOCOPHERYL ACETATE, NIACINAMIDE, CALCIUM PANTOTHENATE, COPPER SULFATE, MANGANESE SULFATE, PYRIDOXINE, HYDROCHLORIDE, RIBOFLAVIN, THIAMINE MONONITRATE, VITAMIN A ACETATE, FOLIC ACID, POTASSIUM IODIDE, SODIUM SELENATE, VITAMIN K1, CHROMIUM CHLORIDE, SODIUM MOLYBDATE, BIOTIN, VITAMIN D3, VITAMIN B12

Allergens

By Nature:
Milk, Soy

DRI Coverage

Meets or exceeds 100% DRI for 25 key vitamins and minerals: 1 - 8 years old, 1000 mL

Meets or exceeds 100% DRI for 26 key vitamins and minerals: 9 - 13 years old, 2000 mL

Meets or exceeds 100% DRI for 26 key vitamins and minerals: Adult (+14 years old), 2000 mL

Product Codes

MODULEN® Unflavored 12 x 14.1oz
HCPCS Code B4152/B4160
NDC-Format Number 41470-0005-30
Case UPC 00041470005317
Each UPC 00041470005300
Product Code 4147000531
  • Modulen™ is a nutritionally complete formula for the special dietary use of children (age 5+), adolescents and adults with Crohn’s disease who choose to follow an enteral diet as either a sole or partial source of nutrition under medical supervision. Meets criteria for partial enteral nutrition as part of the Crohn’s Disease Exclusion Diet (CDED)1.
  • 1. Levine A, et al. Gastroenterology 2019;157:440-450

Notes & Disclaimers for Key Benefits (Healthcare Professionals)

  • 1. Levine A, et al. Gastroenterology 2019;157:440-450.

Protein Source

  • Acid Casein (Milk)

Fat Source

  • Milkfat
  • Medium Chain Triglycerides
  • Corn Oil

Carbohydrate Source

  • Glucose Syrup
  • Sugar
  • Use under medical supervision as part of an exclusive enteral nutrition or partial enteral nutrition diet for indivdiuals with Crohn’s disease
  • Meets criteria for partial enteral nutrition as part of the Crohn’s Disease Exclusion Diet

Important Notes:

NOT FOR PARENTERAL USE ONLY SUITABLE FOR AGES 5 YEARS AND OLDER.

  • Lactose intolerance*
  • Gluten free
  • Halal

Important Notes:

*Not for individuals with galactosemia

GLUCOSE SYRUP, ACID CASEIN (MILK), SUGAR, MILKFAT, MEDIUM CHAIN TRIGLYCERIDES, CORN OIL, AND LESS THAN 2% OF CALCIUM CITRATE, SOY LECITHIN, SODIUM PHOSPHATE, MAGNESIUM CHLORIDE, CALCIUM PHOSPHATE, POTASSIUM CHLORIDE, CHOLINE BITARTRATE, SODIUM CITRATE, SODIUM ASCORBATE, CITRIC ACID, FERROUS SULFATE, ZINC SULFATE, DL-ALPHA TOCOPHERYL ACETATE, NIACINAMIDE, CALCIUM PANTOTHENATE, COPPER SULFATE, MANGANESE SULFATE, PYRIDOXINE, HYDROCHLORIDE, RIBOFLAVIN, THIAMINE MONONITRATE, VITAMIN A ACETATE, FOLIC ACID, POTASSIUM IODIDE, SODIUM SELENATE, VITAMIN K1, CHROMIUM CHLORIDE, SODIUM MOLYBDATE, BIOTIN, VITAMIN D3, VITAMIN B12

By Nature: Milk, Soy

Meets or exceeds 100% DRI for 25 key vitamins and minerals: 1 - 8 years old, 1000 mL

Meets or exceeds 100% DRI for 26 key vitamins and minerals: 9 - 13 years old, 2000 mL

Meets or exceeds 100% DRI for 26 key vitamins and minerals: Adult (+14 years old), 2000 mL

MODULEN® Unflavored 12 x 14.1oz
HCPCS Code B4152/B4160
NDC-Format Number 41470-0005-30
Case UPC 00041470005317
Each UPC 00041470005300
Product Code 4147000531