Etelcalcetide, an intravenous calcimimetic, was approved by the US Food and Drug Administration in 2017 for secondary hyperparathyroidism (sHPT) in patients receiving dialysis.1 Etelcalcetide and cinacalcet, an oral calcimimetic, were subsequently included within the Transitional Drug Add-on Payment Adjustment (TDAPA) program, which paid for calcimimetics as a temporary fee-for-service add-on separate from the dialysis bundle from January 1, 2018, to December 31, 2020. TDAPA was intended to incentivize the use of novel treatments for patients receiving maintenance dialysis, but following temporary reimbursement, payment for calcimimetics was folded into a repriced dialysis bundle (increased by $9.93), with subsequent declines in etelcalcetide prescriptions.