The inclusion of oral phosphate lowering drugs in the dialysis payment bundle starting in January 2025 is a significant change that has sparked debates and discussions within the kidney community. Lori and Jeffrey Silberzweig, MD delve into this topic along with a brief history and evolution of the bundled payment system. They discuss the pros and cons of this action and potential limitations on medication choices for patients. While bundling care encourages healthcare providers to consider overall value and efficiency in their treatment approaches it can prevent individualized treatment plans for delivery of patient care.