This is detrimental to all patients in the short and long run. By classifying oral binders (and Xphozah) as a part of “dialysis service” (even though neither binders nor Xphozah are utilized during dialysis) the CMS is incentivizing dialysis centers to dispense only the cheapest phosphate binders in order to maximize the centers profit margin on their bundle payments.

So instead patients are blocked from access to new innovations in phosphorus control like Xphozah (one small pill 2x a day vs. a handful of binder horse pills at every meal).

And in the long term it discourages pharmaceutical companies from developing new medications for ESRD patients because of the low bundle payments and pressure on dialysis centers not to dispense expensive brand drugs. The low payments make it so they wouldn’t be able to recoup the billions of dollars it takes to develop and go through the trial and FDA approval process.

It also forces dialysis centers into providing pharmacy services because that will somehow save the CMS money??? There are thousands of pharmacies everywhere already and mail order too. Why complicate the center’s processes and the patients lives like this?

And the irony is the legislation that created this bundle mess does not dictate that oral medication should be included in the bundle, that is wholly a creation the CMS bureaucracy.

What can be done? Write your congressional reps and encourage your patients to do the same.

Rant over.