Ensure Patient Access to Innovative Diagnostic Imaging Drugs

Ensure Patient Access to Innovative Diagnostic Imaging Drugs

Cosponsor H.R. 4479/S. 2609, the Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2021

As conditions such as Alzheimer’s and Parkinson’s disease, advanced cardiac disease, and cancers of the prostate, breast and brain continue to exact a heavy toll on elderly Americans, Medicare’s current reimbursement structure limits patient access to innovative imaging tools that improve diagnosis of these deadly diseases.

Advanced diagnostic nuclear imaging procedures use newer innovative diagnostic radiopharmaceuticals for conditions such as heart disease, neurologic disorders, and cancers (i.e., breast, prostate, and neuroendocrine tumors) to provide physicians with more precise diagnostic information. These images support earlier diagnosis and improved treatment decision-making for a growing number of disease states. Advanced nuclear imaging procedures provide previously unavailable information to support changes in patient management which have been demonstrated through literature to lead to more appropriate treatment and reduce the utilization of unnecessary treatments that may be both expensive and debilitating.

Unfortunately, by reimbursing diagnostic radiopharmaceuticals as “supplies” through a “packaged” payment system, the current CMS payment methodology creates a significant barrier to patient access to the newer, more precise generation of diagnostic nuclear imaging drugs. The current CMS methodology “averages” the higher cost of these specialized products with more general and widely-used low-cost radiopharmaceuticals. The result is CMS policy overpays for the low-cost products and reduces reimbursement for the higher-cost products to a point where providers simply choose not to provide these services. The result is the current policy both fails to control costs and restricts access.

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.

---

“Expanding access to the most advanced and effective PET radiopharmaceuticals would

strengthen America’s healthcare system and enhance our ability to diagnose advanced

illnesses earlier and with greater accuracy.”

Dr. Michael Roarke

Chair, Division of Nuclear

Medicine for the Mayo Clinic

Arizona Department of

Radiology

---

CONGRESS CAN INCREASE MEDICARE BENEFICIARY ACCESS TO ADVANCED DIAGNOSTIC IMAGING BY PASSING H.R. 4479/S. 2609, THE FACILITATING INNOVATIVE NUCLEAR DIAGNOSTICS (FIND) ACT

Directing HHS to pay separately for all diagnostic radiopharmaceuticals with a cost threshold per day of $500, providers can better manage costs while also delivering more targeted and cost-efficient care.

Ensure Patient Access to Innovative Diagnostic Imaging Drugs

Cosponsor H.R. 4479/S. 2609, the Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2021

This bill may also:

• Safeguard access to innovations that enhance patient care;

• Improve clinical outcomes;

• Incentivize research, development, and investment;

• Ensure Medicare beneficiaries receive medically necessary studies their physicians prescribe

• The proposed payment changes occur in a budget-neutral manner.

---

To read the full article and see he full list of supporting organizations, please download the file below:

FIND Act One-Pager with supporters

.pdf

Download PDF • 142KB