TDAPA scenarios ?...depends if they ( UNCY , Kidney Care partners ) can break the for profit private dialysis clinics ( 80 % of dialysis population ) insistence that patients get generic Sevelamer ( Renvela )
Usage Breakdown Among Dialysis Patients Total Sevelamer Use: About 62% of all dialysis patients on phosphate binders use sevelamer carbonate or hydrochloride. Generic Dominance: Generics now dominate the volume of sevelamer prescriptions due to significant price differences; generic sevelamer typically costs $3–$10 per day, compared to $15–$40 per day for the brand-name Renvela. Facility Preference: Following the January 1, 2025, Medicare "bundle" update, dialysis centers have almost entirely shifted to generic sevelamer to manage the costs of providing these medications directly under the ESRD PPS bundle.
Patients hate this med ....large pills , many of them ...to be taken with each meal . The major dialysis providers keep patients on them because they say they aren't compensated enough by CMS's dialysis bundle to store and distribute other pho meds that patients may prefer or their MD thinks will work better.
So the worst case scenario is that the best in class pho lowering drug OLC may see limited US use because Fesenius and DaVita will make it hard for patients to get ...and continue to push generic Sevelamer. They would do this because they feel they aren't being compensated enough in the dialysis bundle to buy , store and distribute OLC even tho it may be best in class. The best case scenario is new legislation is passed to increase the coverage of new drugs like OLC ...provide financial incentive to Fresenius and Da Vita in the dialysis bundle ...so that dialysis patients get what may be the best in class drug , rather then being forced to take a drug they all hate.
So thats a wide scenario from a token amount of patients ...say less then 5% ....to over 50% of US patients if sanity were to prevail .
We currently face a situation where the major dialysis providers will make it difficult for patients to get OLC because they feel they aren't getting paid enough to make it available to patients ...despite being best in class for those patents . ( sorry for repeating myself )
WAG ( wild ass guess ). No change , after approval and into 2027 maybe up to $20 a share ...there will be progress in the EU If patient get easier access because Fresenius / Da Vita are some how financially incentivized to make OLC widely available .....maybe $40 a share by end of 2027 including EU approval. If we get wider / easier access , sales in the EU , Japan etc and a 3 yrs TDAPA period ...maybe $60 a share ......at which pt expect definite buyout offers , EU partnership etc ..
62% of dialysis patients are now on a med they hate ...imagine if those patients could be transferred to OLC which they much prefer.
The above assumes approval by June 28th and TDAPA application before July cut off Kiwi
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