CMS issued its end-stage renal disease (ESRD) final rule for CY 2026. In that rule, CMS stated that despite comments requesting that ESRD facilities provide oral drugs and biological products in specific packaging for nursing homes and include the cost of pharmacist and pharmacist technician salaries in the ESRD PPS bundled payment, CMS is not providing detailed responses to these comments in this final rule, but will consider them in future rulemaking. NCPA submitted comments in August to CMS arguing for these reforms.
However, CMS noted that it did not propose to change the additional $36.41 increase to the Transitional Drug Add-on Payment Adjustment (TDAPA) amount for phosphate binders, and CMS is not finalizing any such changes in this rule. As such, the monthly TDAPA amount on any ESRD PPS claim that reports units of phosphate binders in CY 2026 would include the increased $36.41 that CMS finalized in the CY 2025 ESRD PPS final rule.
In the CY 2025 ESRD final rule, effective Jan. 1, 2025, CMS incorporated oral-only phosphate binders into the ESRD Prospective Payment System bundled payment, stating that these therapies are no longer separately billed under Medicare Part D. In comments in August, NCPA argued that patients' previous access to phosphate-lowering therapies (PLTs) through Medicare Part D was an essential lifeline for individuals managing kidney disease. NCPA continued to oppose 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.
