CMS issued a final rule, effective Jan. 1, 2025, that incorporates oral-only phosphate binders into the End-Stage Renal Disease Prospective Payment System bundled payment, stating that these therapies are no longer separately billed under Medicare Part D. NCPA has opposed the bundling of such services, as it threatens to limit access to these therapies at community pharmacies, raise out-of-pocket costs, and undermine care quality for vulnerable patients. Contact the prescriber of a phosphate binder to document a diagnosis before submitting a claim to Part D to confirm the patient is not ESRD getting dialysis.
For the full final rule, click here. CMS has a fact sheet on the rule here.
NCPA
