Issue Background

Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019

Click here to send an email to your congressman asking him or her to cosponsor H.R. 3772

On July 16, Rep. Scott Peters (CA-52) introduced House Resolution 3772, the Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019. This bill, 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.

H.R. 3772 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.

ASRT, along with SNMMI, MITA and CORAR are encouraging Congress to enact H.R. 3772 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.