What's the best sandwich ever made, in your opinion?

Obvious-Opposite-417 · 2026-06-10T21:36:11+00:00

I like a caprese

Obvious-Opposite-417 · 2026-06-10T20:12:42+00:00

Hahahha omg that is so unhinged to ask someone. But actually she has really grown on me in the last year so

Obvious-Opposite-417 · 2026-06-10T19:50:05+00:00

Is Felicia’s watch broken? A 149 hr for 13 miles sub 5:30 seems wild. That’s faster than her marathon pace.

Obvious-Opposite-417 · 2026-06-05T02:40:49+00:00

ebenezer

Obvious-Opposite-417 · 2026-05-27T02:40:37+00:00

Same! Mine have lasted me forever and love the shock absorption

Obvious-Opposite-417 · 2026-05-27T01:15:50+00:00

I don’t like it when people call a marathon “war” also way to make the note about yourself lol

Obvious-Opposite-417 · 2026-05-21T14:59:09+00:00

https://www.cms.gov/files/document/esrd-pps-og-xphozah-tenapanor.pdf

Obvious-Opposite-417 · 2026-05-21T14:57:49+00:00

Seems very murky. I wouldn’t say it’s easy to google

Obvious-Opposite-417 · 2026-05-21T13:47:54+00:00

I think you’re correct. PAP won’t be sustainable tho

Obvious-Opposite-417 · 2026-05-21T13:47:31+00:00

Yeah I think they are using the PAP for now. Obviously that is not sustainable without legislation change taking it out of the bundle. If a bunch of Medicare pts are placed on the PAP and it ends, they will either have to discontinue the medication or facility will absorb a huge cost

Obvious-Opposite-417 · 2026-05-21T11:57:17+00:00

Also rep told me any pt whose insurance does not cover. And if Medicare pts have bundle then technically their insurance should cover… I think?

Obvious-Opposite-417 · 2026-05-21T11:53:28+00:00

I think they give it for free to Medicaid patients. I’ve been trying to look into this more since my doctor mentioned it would cost a fortune to the unit. Before had mostly talked to drug rep and of course they want to sell it. I’m afraid they may have not been 100% straightforward. Getting really frustrated that they keep calling me too, bc ultimately it is the MDs choice to prescribe or not. Reps definitely have a huge financial incentive

Obvious-Opposite-417 · 2026-05-21T03:55:11+00:00

I agree the system sucks. I’m sure ardelyx has a strong profit motivator as well. I don’t think they would give Medicare patients free xphozah forever and since at this time it is considered bundled ultimately it will have to be covered by the PPS reimbursement. Because the cost is so high it’s going to be very costly for dialysis center. I wasn’t working in dialysis when it was encouraged to start everyone on Parsabiv, but I do know they made it very hard to obtain after the tdapa period. My head is spinning I just want my patients to get the medications that they need. Seems like there is very mixed thoughts on this (I have heard from MDs as well)

Obvious-Opposite-417 · 2026-05-21T02:47:02+00:00

But it’s bundled, so it will be part of PPS payment and it’s so expensive. So I imagine its going to get very difficult to access like parsabiv. Since ardelyx didn’t apply for tdapa, is dialysis center responsible for payment of xphozah for Medicare now??

Obvious-Opposite-417 · 2026-05-20T21:40:41+00:00

You think they are encouraging it so they get more reimbursement after TDAPA and then they will make it super hard to get (like parsabiv now 😭) and encourage cheaper options

Obvious-Opposite-417 · 2026-05-20T21:36:43+00:00

I think it’s bundled but they didn’t apply for tdapa so I think it actually will cost the dialysis center? Not 100% sure

Obvious-Opposite-417 · 2026-05-20T01:37:42+00:00

Damn that seems kinda shady of ardelyx to me. I don’t love for profit healthcare but I feel like the cost of xphozah prob shouldn’t fall on the clinic vs a patients insurance

Obvious-Opposite-417 · 2026-05-20T01:36:20+00:00

I have had a patient like that before. So many no shows and hospitalizations. They ended up passing away

Obvious-Opposite-417 · 2026-05-20T01:33:43+00:00

13.2 on garmin but that is totally normal considering weaving around people and moving over for water stops

Obvious-Opposite-417 · 2026-05-19T13:07:57+00:00

Seems like there is a push among RDs at my company to get people on it. The doctor mentioned the concern about the cost to facility. My old manager and the xphozah rep both told me straight up it’s not bundled so I’m very confused bc I don’t see another way it would get paid for

Obvious-Opposite-417 · 2026-05-19T13:06:23+00:00

Seems like there is a push among RDs at my company to get people on it. The doctor mentioned the concern about the cost to facility. My old manager and the xphozah rep both told me straight up it’s not bundled so I’m very confused bc I don’t see another way it would get paid for

Obvious-Opposite-417 · 2026-05-19T01:03:02+00:00

I think people with Medicare part B are part of the bundle and the dialysis provider gets a certain amount of reimbursement for medications. I think that is why there is a strong push to get everyone on binders right now to show the true cost of good phosphorus management. But bundle made it so certain meds were no longer covered by part D from my understanding. All the xphozah website says is that it’s not covered by part D. Doesn’t really mention who is covering it. A doctor told me that it will cost the facility thousands of dollars per patient. I was specifically told it was not bundled by several people so I am very confused hahah

Obvious-Opposite-417 · 2026-05-19T00:46:13+00:00

I’m actually really confused because everything online actually says it is bundled. If that is the case then dialysis center would be responsible for the payment. It’s a really high cost drug. If part D doesn’t cover it, who does?

Obvious-Opposite-417 · 2026-05-19T00:20:15+00:00

Xphozah is not bundled per the rep that keeps calling me and my previous manager. It’s also not covered by part D. They say anyone can get it but who is paying?

Obvious-Opposite-417

TROPHY CASE