Medicare does cover Auryxia (ferric citrate), but how it’s covered depends entirely on why you’re taking it. If you’re on dialysis and using Auryxia as a phosphate binder, it’s covered under Medicare Part B as of January 1, 2025, and your dialysis facility now supplies it directly. If you have chronic kidney disease but aren’t on dialysis and were prescribed Auryxia for iron deficiency anemia, Medicare Part D will not pay for it. CMS rescinded that coverage in 2018, and the exclusion still stands.
If You’re on Dialysis
Auryxia is covered. Starting January 1, 2025, CMS folded oral-only phosphate binders into the End-Stage Renal Disease Prospective Payment System, the bundled payment that Medicare Part B makes to dialysis facilities.1CMS.gov. MLN Connects Newsletter That means Auryxia is now part of the dialysis service itself rather than something you pick up at a retail pharmacy under Part D.
In practice, your dialysis facility provides the drug to you directly. The National Kidney Foundation has confirmed Auryxia is among the phosphate binders handled this way under the 2025 changes.2National Kidney Foundation. Phosphate-Lowering Agents CMS Changes One of the reasons CMS made the shift was to improve access for dialysis patients who didn’t have Part D coverage or whose drug plans weren’t generous enough to cover binders affordably.3MedPAC. MedPAC Comment on ESRD PPS CY2025
If you were previously filling Auryxia at a pharmacy under Part D, that pathway no longer applies for the dialysis indication. Talk to your dialysis facility about how they’re dispensing it.
If You Have CKD but Aren’t on Dialysis
This is the harder answer. In September 2018, CMS rescinded Part D coverage for Auryxia when it’s prescribed to treat iron deficiency anemia in adults with CKD who are not on dialysis.4Akebia Therapeutics. Akebia Files Lawsuit Against CMS Federal law excludes “prescription vitamins and mineral products” from Part D, and CMS classified Auryxia as a mineral product when used to treat iron deficiency. On that reading, the drug falls inside the exclusion.5FindLaw. Akebia Therapeutics Inc v Azar II, District Court
Akebia Therapeutics, the manufacturer, sued CMS in October 2019 to try to restore coverage. The U.S. District Court for the District of Massachusetts denied the company’s motion for a preliminary injunction, and the First Circuit affirmed. Both courts agreed the mineral product exclusion covers synthetic compounds and that the FDA itself labels Auryxia as an iron replacement product.6FindLaw. Akebia Therapeutics Inc v Azar II, First Circuit Akebia voluntarily dismissed the lawsuit in October 2021, citing the cost of further litigation and CMS’s unwillingness to shift its position. The company said it would pursue a legislative fix instead.7Akebia Therapeutics. Statement From Akebia Therapeutics Regarding Litigation No legislation restoring coverage has taken effect.
So if you’re in this group, Medicare will not pay for Auryxia under Part D. The 2025 Part B changes don’t help here either; the bundled payment applies to dialysis patients using the drug as a phosphate binder, not to non-dialysis patients using it for anemia.
What Auryxia Costs and Where to Get Help
Auryxia is expensive. The average retail price is about $293 for 30 tablets, and a typical monthly supply of 300 tablets can run $400 to $500 at list price.8SingleCare. Auryxia Prescription Prices9DrugPatentWatch. Auryxia Drug Pricing A generic version made by Teva Pharmaceuticals received FDA approval in March 2026, but active patents extend as far as 2030, and it isn’t clear when the generic will actually reach pharmacy shelves.10Drugs.com. Generic Auryxia Availability
If you’re paying out of pocket, several programs can help:
- AkebiaCares, the manufacturer’s patient support program, investigates your insurance coverage, confirms your out-of-pocket cost, and reviews you for income-based financial assistance. Enroll by calling 855-686-8601 or through the Auryxia website.11Auryxia.com. AkebiaCares Enrollment Form
- Medicare Part D Extra Help lowers deductibles and copays for beneficiaries with limited income. Apply through the Social Security Administration.12National Kidney Foundation. Prescription Discount and Assistance Resources
- Nonprofit foundations including the Patient Access Network (PAN) Foundation, The Assistance Fund, and the American Kidney Fund offer need-based grants toward copays and medication costs for kidney patients.13American Kidney Fund. Prescription Drug Resources
- About 15 states run kidney-specific pharmaceutical assistance programs that help cover outpatient medications for dialysis and transplant patients.12National Kidney Foundation. Prescription Discount and Assistance Resources
If you were counting on Part D to cover Auryxia for anemia and recently learned it won’t, the manufacturer’s program is usually the first call to make, because it screens you for every other assistance option at the same time.