Medicaid Update – Updated Implementation Date: Ambulatory Patient Group Weight Adjustment for Phosphate Binders
IMPACTED PLANS: Medicaid Managed Care, PIC, & HARP
TO: All Primary Care Providers
The previously announced update to the Medicaid policy to include phosphate binder costs in the dialysis clinic APG rate has been delayed until January 1, 2026. Until that date, dialysis patients may continue to obtain phosphate binders through the pharmacy benefit.
Reminders:
- The APG weight for dialysis (APG 168) reverts to 1.3651, retroactive to July 1, 2025.
- Claims paid at the higher weight (1.5302) will be automatically reprocessed; providers do not need to resubmit.
Effective as of January 1, 2026:
- Phosphate binder prescription drugs for dialysis patients will no longer be covered as a pharmacy benefit and must be provided by the dialysis clinic.
- APG weight will increase to include binder costs.
- Dialysis clinics must dispense phosphate binders; they will no longer be covered under the pharmacy benefit.
- Managed Care payments will also include binder costs.
No immediate action is required.
For more details, please refer to the NYS Medicaid Update.
If you have any questions regarding this memo, please contact MetroPlusHealth at: [email protected].
last updated: January 7, 2026