From the June 2022 issue of HealthCare Business News magazine

By Geoffrey B. Johnson, Thomas A. Hope and Christina M. Arenas

Within the last year, we’ve seen two new imaging agents to detect prostate cancer and one revolutionary therapeutic. Although the science is state-of-the-art, the Medicare reimbursement policy for radiopharmaceuticals, particularly in the outpatient hospital setting, is lagging decades behind.

The bipartisan Facilitating Innovative Nuclear Diagnostics (FIND) Act will rectify reimbursement and ensure that patients have access to cost-effective nuclear medicine procedures that could change the course of their treatment.
Lack of proper Medicare reimbursement for diagnostic radiopharmaceuticals blocks patient access to novel diagnostics and cancer therapies
The ability of patients to get access to lifesaving next-generation diagnostic and therapeutic radiopharmaceuticals is at serious risk due to an outdated Medicare reimbursement policy for diagnostic radiopharmaceuticals. Often people outside of the nuclear medicine community struggle to understand how these radiopharmaceuticals are used and how critical they are in the care of patients — and by extension, the significant negative impact that lack of proper reimbursement has on patient care. The result of bundling a novel diagnostic radiopharmaceutical into the cost of a PET or SPECT scan is that medical centers lose significant amounts of money on every scan they perform with a novel diagnostic radiopharmaceutical on a Medicare patient. This results in medical centers choosing not to offer the new technology to any patients, especially in medical centers that are already struggling financially. This, in turn, blocks access to related anti-cancer radiopharmaceutical therapies. The Facilitating Innovative Nuclear Diagnostics (FIND) Act (H.R. 4479/S.2609) seeks to resolve this issue in a budget-neutral manner.

Medicare reimbursement policy was initially created in an environment when IV contrast used in CT and MR scans was the dominant consideration
People may think a diagnostic radiopharmaceutical is a relatively inexpensive and optional supply for a PET or SPECT scan — as, for example, IV contrast is when used during an MR or CT; however, this is inaccurate. A CT or an MR scan can be performed without IV contrast, or IV contrast can be added to improve the CT or MR for certain indications. CT and MR images are created by a CT or MR scanner interacting with the body, and the IV contrast is optional. The IV contrast is most often less expensive than the cost to perform the CT or MR scan.

June 2022 Magazine

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