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July 26, 2010


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I just skimmed it and I can't tell if Sensipar and Renvela are in the bundle or not. It states that all ESRD oral meds are in the bundle that were previously separately billable under Medicare Part D. I imagine that would include Renvela and Sensipar, am I misinterpreting it? Anythoughts

Bill Peckham

Page 71:
Consistent with section 1881(b)(14)(B)(iii) of the Act, we are including the oral equivalents of ESRD injectable drugs in the payment bundle effective January 1, 2011. These drugs include the oral Vitamin D analogues (calcitriol, doxercalciferol, and paracalcitol) and levocarnitine. Oral iron is generally available over the counter and not covered under Parts B or D. Therefore, it is not included in the payment bundle. There are currently no oral versions of ESAs for inclusion in the ESRD PPS. For reasons set forth in greater detail response to the comment below, we have adopted the commenter’s suggestion that the inclusion of oral-only drugs be delayed until after the end of the transition period, or until January 1, 2014.

I read this to mean "Oral Drugs" will not be included until 2014, not clear if they'll be included at the proposed $ amount.

Richard King

I usually receive benedryl IV, I itch when I am on dialysis and this is the only thing that works. I have been on Dialysis for 23 yrs and 11 months. the first time I heard about this Bundling, was last friday. When someone brought over a piece of paper saying that as of 01Jan2011 I can get no more that I will have to take the capsules before I leave at 5:30 a.m. no one has ever discussed it with my Dialysis Unit patients. I live in WA state and goto St. Joseph's Dialysis unit is there any way around this? And as I read this has been in the works for months, heck even years. why the change now and is this going to reduse my time on earth?

Roberta Mikles

Richard, as I read your post and you state that you never heard of this bundling,I become very frustrated. I have attempted, in speaking with many that patients NEED to be educated and informed on that which will affect them e.g. bundling. When the bundling was being proposed, I had asked a provider group if they would help me in disseminating information on bundling to patients here in California. I got NO response. Then, later, down the road, I spoke with the head of one of the chains (SW) and suggested that providers give patients any proposed rule information that might affect them so that they, the patient, can comment if they so desire. Afterall, the proposed rules affect patients, so why not have all patients be aware of such. Then I had suggested that the ESRD Networks send to each faciity a one-page FAQ sheet on whatever proposed rule is out there. The unit would then make copies for all patients. The FAQ paper would have reference phone numbers and websites for patients to reference. I just can not believe that providers do not care enough to educate their patients on various laws that might affect their care. This, in and of itself truly shows the lack of respect for patients..in my opinion. Providers are well aware that there are many patients who would comment if they knew a law would affect their care or their financial status. This is so unacceptable. I just continue to shake my head.
If any providers are reading this I would strongly suggest that you start educating patients on such that might affect them. When the bundling first came out, I tried to talk to many patients about the bundling. some wanted to know and some did not. It was hard talking to other patients because staff did not like the fact that I walked around and communicated with patients. Even the staff were unfamiliar with such and some would ask me questions. I guess as my late father always said 'treat patients the way you would want to be treated, or you would want a loved one to be treated.' Will this truly ever happen..... Business as usual... I guess.. what will it take to have providers realize that patients pay their salaries and if it were not for patients they would not have jobs.
Roberta Mikles

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