The Fidelis Care Blog

Fidelis Care would like to remind providers of the upcoming change to Medicaid pharmacy benefits for phosphate binders used by dialysis patients.

Effective January 1, 2026, phosphate binder prescription drugs for New York Medicaid members utilizing dialysis will no longer be covered as a pharmacy benefit via NYRx, the Medicaid Pharmacy Program, and must be provided by the dialysis clinic as part of the bundled dialysis payment. See below for a list of Phosphate Binders:

• Auryxia™


• Calcium acetate


• Ferric citrate


• Fosrenol®


• Lanthanum carbonate


• Renvela®


• Sevelamer carbonate


• Sevelamer HCl


• Velphoro®


• Xphozah®

 

For additional information, please see the following communications from the New York State Department of Health (NYSDOH)

• Member Notification - Changes to Coverage of Phosphate Binders of Patients on Kidney Dialysis


• Pharmacy Notification: Phosphate Binders Coverage Updates

Please Note: This notice does not apply to Child Health Plus, Essential Plan, and Qualified Health Plan members.  Child Health Plus, Essential Plan, and Qualified Health Plan members will continue to receive their phosphate binders from the pharmacy benefit.

Fidelis Care would like to remind providers of the upcoming change to Medicaid pharmacy benefits for phosphate binders used by dialysis patients.

Effective January 1, 2026, phosphate binder prescription drugs for New York Medicaid members utilizing dialysis will no longer be covered as a pharmacy benefit via NYRx, the Medicaid Pharmacy Program, and must be provided by the dialysis clinic as part of the bundled dialysis payment. See below for a list of Phosphate Binders:

• Auryxia™


• Calcium acetate


• Ferric citrate


• Fosrenol®


• Lanthanum carbonate


• Renvela®


• Sevelamer carbonate


• Sevelamer HCl


• Velphoro®


• Xphozah®

 

For additional information, please see the following communications from the New York State Department of Health (NYSDOH)

• Member Notification - Changes to Coverage of Phosphate Binders of Patients on Kidney Dialysis


• Pharmacy Notification: Phosphate Binders Coverage Updates

Please Note: This notice does not apply to Child Health Plus, Essential Plan, and Qualified Health Plan members.  Child Health Plus, Essential Plan, and Qualified Health Plan members will continue to receive their phosphate binders from the pharmacy benefit.