por John R. Fischer
, Senior Reporter | August 10, 2021
Politicians on both sides of the Senate floor introduced legislation this month that would increase affordable access among Medicare beneficiaries to diagnostic imaging agents used in nuclear medicine and molecular imaging scans.
Under the Facilitating Innovation Nuclear Diagnostics (FIND) Act of 2021, Health and Human Services would make radiopharmaceuticals more affordable for providers and in turn, increase access for patients to necessary nuclear medical exams.
“The FIND Act would increase patient access to more cost-effective treatment options while promoting further research and development opportunities for medical manufacturers,” said Sen. Marsha Blackburn, R-Tenn., who introduced the bill alongside Sen. Tammy Baldwin, D-Wis., in a statement.
While scientific advancements have made radiopharmaceuticals more precise and insightful for physicians, their use is limited by current payment rules, which package diagnostic RP drugs into nuclear medicine procedure payments for hospitals in outpatient settings. This leads to underpayments in reimbursement that make hospitals less inclined financially to use these drugs with patients. For instance, many safety-net hospitals and providers are unable to afford these imaging agents, thereby preventing patients from undergoing medically necessary nuclear imaging exams.
If passed, the legislation is expected to give patients access to a wider selection of diagnostic radiopharmaceuticals that can better detect heart disease, Alzheimer’s, Parkinson’s disease, breast and prostate cancer, and neuroendocrine tumors, among other conditions. Providers will also be able to better manage costs and deliver more targeted care.
Under the FIND Act, the secretary of health and human services would form a separate payment policy under the Medicare Hospital Outpatient Prospective Payment System for diagnostic RP drugs on the market since January 2008. It would go over a per-day cost threshold of $500. The bill is also budget-neutral, meaning it does not require tax increases to cover such care.
“The FIND Act provides a legislative solution to modernize CMS payment policies for PET diagnostic radiopharmaceuticals and expand access," said Sue Bunning, MITA industry director of molecular imaging and PET, in a statement
. "The FIND Act will also encourage innovators, product developers and other interested parties in the medical technology space.”