From the June 2022 issue of HealthCare Business News magazine
There is widespread support for a change in Medicare policy around diagnostic radiopharmaceuticals
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and its partners, the Medical Imaging and Technology Alliance (MITA) and the Council on Radionuclides and Radiopharmaceuticals (CORAR), have been working together for over a decade to reform CMS’s bundling of diagnostic radiopharmaceuticals. Though packaged payment models may work in certain instances, they have created a significant disincentive for the use of a small subset of novel, high-value diagnostic radiopharmaceuticals in hospitals. Consequently, Medicare beneficiaries are not getting access to medically necessary diagnostic radiopharmaceuticals for many types of cancer, Alzheimer’s, and Parkinson’s diseases.
The FIND act proposes to resolve this issue in a cost-neutral manner
The Facilitating Nuclear Diagnostics (FIND) Act, introduced in the House and Senate in the summer of 2021, seeks to fix the patient access issues by allowing diagnostic radiopharmaceuticals (whose mean cost per day is equal to or above $500) to be reimbursed separately in the outpatient hospital setting. This means the diagnostic radiopharmaceuticals would be reimbursed close to their pass-through rate. The FIND Act is budget-neutral and waives diagnostic radiopharmaceuticals copayments for Medicare beneficiaries.
About the authors: Geoffrey B. Johnson, M.D., Ph.D., is the chair of nuclear medicine at Mayo Clinic in Rochester, MN. Thomas A. Hope, M.D., is associate professor in residence at University of California, San Francisco. Christina M. Arenas, J.D., MPH, is associate director of health policy & regulatory affairs at SNMMI.
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