HCB News: How do conventional contrast agents used in CT and MR factor into this conversation, if at all?
MG: Conventional contrast agents used in CT and MR do not factor into this conversation as there is a separate reimbursement track for their clinical use. However, CT and MR contrast agents are unable to match precise diagnostic information that can be provided by nuclear medicine techniques using precision-targeted radiopharmaceuticals.

HCB News: What are some of the criticisms opponents of the FIND Act point toward when advocating against it?

MG: Currently, the FIND Act is supported by more than 88 stakeholder organizations, including patient advocacy organizations. No patient group, hospital organization, or industry stakeholders are advocating against it.

HCB News: If enacted, the FIND Act would pertain only to drugs approved by the FDA since 2008 with a mean cost per day of $500 or above. Why those specifications, and what are the main drugs / scans that it would impact?
MG: More than 40 diagnostic radiopharmaceutical drugs are approved by the FDA and currently used for nuclear medicine imaging. Most of these drugs are generic, and for those, “bundling” provides adequate Medicare reimbursement for hospitals; however, bundling does not provide adequate reimbursement for a small subset of precision diagnostic radiopharmaceutical drugs used for narrower and targeted patient populations. These newer drugs provide for a future of more personalized medicine and offer diagnostic advantages over previous generations of diagnostic radiopharmaceutical drugs.

These newer precision diagnostic radiopharmaceutical drugs were FDA-approved after January 1, 2008. Because they are used for narrower and targeted patient populations, they tend to have significantly higher costs. Therefore, these specifications focus the legislative solution on a specific Medicare reimbursement problem impacting Medicare beneficiaries.

HCB News: It's easy to assume improving access to advanced exams and treatments must correlate directly with increasing costs to an already overburdened healthcare system. What do you say to that?
MG: Providing the best diagnostic information available for the patient provides the greatest economic advantage. Medicare is currently paying for therapies, surgery, and hospital stays that would not have been chosen if the most effective diagnostic procedures had been available when needed. In other words, nuclear medicine techniques using precision diagnostic radiopharmaceuticals result in overall cost savings to the healthcare system by avoiding unnecessary and expensive surgeries and expensive therapies in a subset of patients. In fact, there is a strong evidence base to this effect in the literature dating back to late 1990s that was reviewed by the CMS, resulting in the first round of approvals of these techniques in early 2000.

If passed, the FIND Act will ensure that diagnostic nuclear medicine procedures are available to physicians and patients when they are the best and most appropriate choice, eliminating alternative procedures that are less effective. It will improve diagnostic efficiency, reduce costs, and improve patient care and outcomes.

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