Contact Federal Lawmakers
Ask to have the payment for radiopharmaceuticals unbundled from othe overall Medicare reimbursement for nuclear medicine procedures.
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The Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2021 has been introduced by Marsha Blackburn as Senate Bill 2609 and by Representative Scott Peters as House Resolution 4479. These bills, supported by ASRT, the Society of Nuclear Medicine and Molecular Imaging, Medical Imaging and Technology Alliance and Council on Radionuclides and Radiopharmaceuticals will help ensure equitable Medicare payment for diagnostic radiopharmaceuticals used in precision testing and preserve patient access to new, innovative imaging procedures.
The FIND Act will change the way Medicare reimburses providers for radiopharmaceuticals by unbundling them from the overall Medicare reimbursement for nuclear medicine procedures. Diagnostic radiopharmaceuticals are drugs, as defined by statute, but despite acknowledging concerns about growing patient access issues as the industry evolves, CMS has treated them as supplies and has packaged them into procedural bundles, known as Ambulatory Payment Classifications. This bundling of radiopharmaceuticals as part of the APC has proved to be problematic since diagnostic radiopharmaceutical costs may vary widely within a nuclear medicine APC and may at times exceed the complete APC payment. This translates into a strong disincentive for hospitals to utilize innovative, targeted radiopharmaceuticals, serves to discourage investment in and research for new diagnostic radiopharmaceuticals and may impede patient access to the most appropriate diagnostic tools at readily accessible health care locations. In addition, this may also result in inaccurate diagnoses and ineffective treatment plans.
Since 2008, Medicare has “packaged” payment for diagnostic radiopharmaceuticals into payment for the molecular imaging tests conducted by nuclear medicine providers in hospital outpatient facilities. Physicians use these tests to diagnose cancer and cardiac conditions, as well as degenerative neurological diseases such as Parkinson’s and Alzheimer’s diseases, and determine the appropriate course of treatment for their patients.
Medicare’s packaged rates for such studies are the same regardless of whether they involve a high-volume, lower-cost diagnostic radiopharmaceutical or a low-volume, higher-value precision diagnostic tool that can facilitate more targeted treatment—even when the cost of the precision medicine drug can substantially exceed the entire packaged reimbursement.
Reimbursing appropriately for newer, more advanced radiopharmaceuticals would align CMS reimbursement for many other drugs- including those in the Outpatient Prospective Payment System (OPPS) and radiopharmaceuticals in the Medicare Physician Fee Schedule (MPFS). Removing higher-cost radiopharmaceuticals from the packaging system would also correct some of the current overpayment for the high-volume, lower-cost radiopharmaceuticals.
ASRT, along with SNMMI, MITA and CORAR are encouraging Congress to enact S. 2609 and H.R. 4479 so that patients receive the best available nuclear medicine and molecular imaging tests leading to quick and complete diagnoses, accurate treatment plans and ultimately a successful cure for Alzheimer’s disease, Parkinson’s disease, cardiovascular disease, cancer and other illnesses.