Comprehensive medication guide to Velphoro including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0 for most Medicare ESRD fee-for-service patients through the ESRD Prospective Payment System (as of January 2025); $0 copay for commercially insured patients with Velphoro Savings Card; $50–$200+ copay for Medicare Part D and commercial plans without savings card — prior authorization and step therapy (calcium acetate first) typically required.
Estimated Cash Pricing
$2,092–$2,157 retail for brand-name Velphoro (no generic available); as low as $1,557 with SingleCare or GoodRx discount cards for a 30-day supply (90 tablets). Velphoro Savings Card for commercially insured patients can reduce cost to $0 (up to $1,500 savings/prescription).
Medfinder Findability Score
55/100
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Velphoro is the brand name for sucroferric oxyhydroxide, an iron-based phosphate binder approved by the FDA in November 2013. It is indicated for the control of serum phosphorus levels in adults and pediatric patients 9 years of age and older with chronic kidney disease (CKD) on dialysis. There is no generic version available as of 2026.
Velphoro is manufactured and distributed by Fresenius Medical Care North America. It comes as a round, brown, chewable tablet embossed with 'PA 500' on one side. Each tablet contains 500 mg of iron as sucroferric oxyhydroxide and has a berry flavor. Patients must chew or crush it before swallowing and take it with every meal.
One of Velphoro's main clinical advantages is its low pill burden: most patients need just 1 tablet per meal (3 per day at the starting dose), compared to 3–4 tablets per meal with sevelamer-based binders. This significantly improves medication adherence, which is critical in dialysis patients who must take many medications daily.
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Velphoro works by binding dietary phosphate in the gastrointestinal (GI) tract before it can be absorbed into the bloodstream. Its active ingredient — polynuclear iron(III)-oxyhydroxide — is practically insoluble in water and works entirely within the gut without being absorbed into the body.
The mechanism is called ligand exchange: when Velphoro travels through your digestive tract alongside food, phosphate ions from the food swap places with hydroxyl groups on the surface of the iron compound and bind tightly to it. In vitro studies show Velphoro can bind up to 96% of available phosphate. The iron-phosphate complex is then eliminated in the feces, resulting in lower serum phosphorus and calcium-phosphorus product levels.
Velphoro maintains its phosphate-binding capacity across the full physiological pH range of the GI tract — from the acidic stomach to the more neutral small intestine — which makes it effective throughout the digestive process. The medication must be chewed or crushed (not swallowed whole) to maximize its surface area and binding capacity.
500 mg — chewable tablet
Starting dose for adults and patients 12+: 1 tablet (500 mg) three times daily with meals. Maximum 6 tablets (3,000 mg) per day. Must be chewed or crushed — do not swallow whole.
500 mg — chewable tablet (pediatric)
For pediatric patients 9 to under 12 years: 1 tablet two times daily with meals. Titrate as needed weekly.
Velphoro is not typically stocked at retail pharmacies like CVS, Walgreens, or Walmart. It is primarily dispensed through dialysis centers and specialty pharmacies. As of January 1, 2025, most Medicare ESRD fee-for-service patients receive Velphoro directly from their dialysis facility at no additional cost under the ESRD Prospective Payment System — so the pharmacy question does not apply to most Medicare dialysis patients.
For patients with commercial insurance or Medicare Advantage who need to fill through a pharmacy, finding Velphoro requires going to specialty pharmacy channels — including the official Velphoro Concierge Support program (888-222-5270) powered by ASPN Pharmacies, which offers home delivery. medfinder calls pharmacies near you to identify which ones can fill your Velphoro prescription, saving you hours of calling around on your own.
Velphoro is not a controlled substance and has no special DEA prescriber requirements. It can be prescribed by any licensed healthcare provider. However, because it is exclusively used in dialysis patients, it is almost always managed by kidney specialists and dialysis care teams. Most insurance plans require that the prescriber be a nephrologist or be in consultation with one for prior authorization approval.
Nephrologists — primary prescribers; manage dialysis patients and phosphorus monitoring
Dialysis center physicians — manage all medical care for dialysis patients at the center
Internal medicine physicians — may prescribe for established patients in consultation with nephrology
Nurse practitioners (NPs) and physician assistants (PAs) — can prescribe within state scope of practice; often part of nephrology or dialysis teams
Telehealth prescribing of Velphoro is not appropriate for initial prescriptions due to the need for serum phosphorus monitoring and dialysis care. Established dialysis patients may be able to obtain prescription renewals via telehealth nephrology visits in some practices.
No. Velphoro (sucroferric oxyhydroxide) is not a controlled substance and is not scheduled by the DEA. It does not have any special prescribing requirements related to controlled substance regulations. Any licensed physician, nurse practitioner, or physician assistant can prescribe Velphoro without a DEA registration.
Velphoro is a prescription-only medication (not available over the counter), but this is for clinical reasons — it requires monitoring of serum phosphorus levels — not because of abuse potential or controlled substance scheduling. It cannot be refilled without a new prescription in most states, but this is standard for most brand-name specialty drugs.
Discolored (dark or black) stools — most common (12% of patients); caused by iron and considered normal
Diarrhea (6% of patients); usually improves with continued use
Tooth staining — due to iron content; minimized by brushing teeth after taking the tablet
Nausea — particularly at higher doses; take with a full meal to reduce
Constipation — especially at higher doses
Severe allergic reactions: hives, swelling of face/lips/throat, difficulty breathing — stop Velphoro and call 911
Signs of GI bleeding: vomiting blood, blood-streaked stools, severe abdominal pain
Iron overload signs in high-risk patients (hemochromatosis, hepatic disorders) — monitor iron labs
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Sevelamer carbonate (Renvela)
Non-calcium, resin-based binder. Generic available and far less expensive (~$49-$100/month). Equally efficacious but requires 3-4 tablets per meal — higher pill burden than Velphoro.
Ferric citrate (Auryxia)
Iron-based phosphate binder similar to Velphoro. Also raises iron stores, which may benefit iron-deficient dialysis patients. Brand-name only; comparable cost to Velphoro.
Lanthanum carbonate (Fosrenol)
Non-calcium, non-iron binder. Generic available. Lower pill burden vs. sevelamer. Available as chewable tablet or powder — useful for patients who struggle with chewing.
Calcium acetate (PhosLo)
Inexpensive calcium-based binder; often required as step therapy before insurance approves Velphoro. Use with caution in hypercalcemia. Generic widely available at very low cost.
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Levothyroxine (Synthroid)
moderateVelphoro inhibits GI absorption of oral levothyroxine. Take levothyroxine at least 4 hours before Velphoro. No interaction with parenteral levothyroxine.
Doxycycline
moderateVelphoro binds doxycycline in the GI tract, reducing antibiotic effectiveness. Take doxycycline at least 1 hour before Velphoro.
Alendronate (Fosamax)
moderateVelphoro binds alendronate in the GI tract. Take alendronate at least 1 hour before Velphoro.
Erdafitinib (Balversa)
majorAvoid co-administration during the first 21 days of erdafitinib therapy. Phosphate binders can mask the serum phosphate rise used to guide FGFR inhibitor dose titration.
Electrolyte-altering agents (sodium sulfate / magnesium sulfate / potassium chloride solutions)
moderateCo-administration may increase risk of seizure, arrhythmias, and renal impairment. Use with caution.
Velphoro (sucroferric oxyhydroxide) is a safe and effective phosphate binder for CKD patients on dialysis, with a key clinical advantage: its very low pill burden of just 1 tablet per meal makes it one of the easiest phosphate binders to adhere to. It is non-calcium, non-aluminum, and works effectively across the full range of gut pH. FDA-approved since 2013, it has a well-established safety and efficacy profile in both hemodialysis and peritoneal dialysis patients.
The main challenges with Velphoro are its high cost (~$2,000/month retail), lack of generic availability, and limited retail pharmacy stocking. As of 2025, most Medicare ESRD patients receive it at no cost through their dialysis facility. Commercially insured patients can use the Velphoro Savings Card to bring their copay to $0. Patients who face access barriers should contact Velphoro Concierge Support (888-222-5270) or their dialysis care team.
If you're having trouble finding Velphoro at a pharmacy near you, medfinder calls pharmacies in your area to find which ones can fill your prescription and texts you the results — making the search faster and less stressful.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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