A recent letter addressed to the acting Centers for Medicare and Medicaid Services (CMS) administrator, Elizabeth Richter, by Representative Scott Peters of California and Representative Bobby Rush of Illinois, expressed concern over reimbursement methodology as it concerns radiopharmaceuticals (a group of pharmaceutical drugs with radioactive isotopes used in diagnostic and therapeutic agents).
Miami, FL -- (SBWIRE) -- 04/22/2021 -- Nuclear medicine studies organ anatomy and evaluates its function to optimize a doctor's ability to find the best possible treatment plan. Diagnostic radiopharmaceuticals are necessary drugs to enable all nuclear medicine imaging studies to properly diagnose and determine the severity of a disease.
Roughly 20 million Americans benefit from nuclear medicine exams in any given year, but there are still roadblocks in federal payment programs that are preventing coverage.
Two United States Congressmen have brought their concern forth to the CMS, calling the payment policies "flawed" for diagnostic imaging drugs.
In the letter, the two representatives write, "The nuclear medicine industry is developing exciting new drugs to provide precision imaging for hard-to-diagnose diseases such as Alzheimer's disease, Parkinson's disease, cardiovascular disease, and prostate, breast, and neuroendocrine cancers," and that "The flawed reimbursement policy utilized by the Centers for Medicare and Medicaid Services threatens patient access to these cutting-edge innovations by creating a disincentive for hospitals to use the most appropriate diagnostic drugs."
Diagnostic radiopharmaceuticals must be approved by the Food and Drug Administration (FDA), but since 2008, CMS has treated them as a supply "ancillary to" the packaged procedure and after three years of a pass-through payment period, has "policy packaged" their cost into procedure amounts through the Ambulatory Payment Classification (all in hospital settings).
In December of 2020, CMS issued the Final Rule for 2021, which rejected the recommendations of its Advisory Committee and stakeholders from the provider and patient community in order to unpackage diagnostic radiopharmaceuticals.
Both representatives are asking that Richter meet with them to discuss the issue and hopefully the potential of policy change from CMS.
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