Options for CKD Patients with Acidosis When Insurance Won’t Cover Sodium Bicarbonate

One job of the kidneys is to remove acid. When the kidneys fail, acid can build up in the body and cause progression of chronic kidney disease. We nephrologists commonly prescribe doses of sodium bicarbonate to counter the effects of this process. The strategy is quite effective. What to do when there are competing priorities, for example, when patients have to purchase multiple medications, and they can’t afford the sodium bicarbonate? What to do when insurance won’t cover all the sodium bicarbonate? Or insurance will only cover part of it?

One strategy is to use less. We have done that. Another option patients choose is paying cash using GoodRx. Here is the link to GoodRx for sodium bicarbonate:

GoodRx offers a discount for sodium bicarbonate at multiple pharmacies.

At the time of this writing, the cheapest you can get 180 tablets of sodium bicarb, 650 mg, with the free coupon is $2.68. See what the other dosage, 325 mg would cost. Also, please note what different pharmacies will charge you.

Another option we use at Lincoln Nephrology and Hypertension is baking soda.

Instead of sodium bicarbonate tablets, consider baking soda.

The conversion from sodium bicarbonate to baking soda is:

*If your nephrologist prescribes sodium bicarbonate 325 mg twice a day, then you should take 1/2 a teaspoon of baking soda twice a day *If your nephrologist prescribes sodium bicarbonate 650 mg twice a day, then you should take 1 teaspoon of baking soda twice a day. *Adjust to effect. So the kidney provider will recheck level and ask you to either increase or decrease the amount or the frequency (number of times per day) until we achieve our desired goal. *If too much baking soda is used, your nephrologist will suggest less.

The conversion is that simple. Some patients can tolerate the taste of baking soda. Others aren’t able to tolerate it. We have a conversation with the patient to discuss best options, using an individualized approach to care.

Of note, we have talked about sodium bicarbonate, metabolic acidosis, and prevention of chronic kidney disease in a prior article post. We will link to that here:

Too Much Acid in My Body and CKD. What Should I Do?

Please check that article out and learn more about prevention of chronic kidney disease using bicarbonate. That article discusses the risks, the benefits, and other options you might consider if sodium bicarbonate in either the pill or baking soda formulation will not work for you.