Category: MVP (NY/VT) Insurance Payer

To align with NYS Medicaid ESRD reimbursement for oral-only phosphate binders- MVP will include the reimbursement in the newly aligned Dialysis center APG reimbursement. Effective for any DOS 1/1/2026.

Higlights:

1. Oral only Phosphate binders for ESRD members no longer will be dispensed through the pharmacy NYRx benefit
2. The Phosphate binders will be dispensed by the dialysis center
3. Reimbursement- no separate reimbursement will be made for oral only phosphate binders instead it is included in the new APG dialysis rate
4. Dialysis centers should not bill a separate claim for these phosphate binders (ESRD patients)
5. Oral only phosphate binders affected by this change: sevelamer carbonate, lanthanum carbonate, sucroferric oxyhydroxide, and ferric citrate.

NYS APG rate:

The FFS APG weight for APG 168 (dialysis) has increased from 1.3651 to 1.5302. 

For the NYS Medicaid announcement click here .

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