MITA asks CMS to improve radiopharmaceutical coverage

The Medical Imaging and Technology Alliance (MITA) has raised concerns over a proposed 2024 Medicare rule covering how the Centers for Medicare and Medicaid Services (CMS) pays for diagnostic radiopharmaceuticals used in nuclear medicine.

"Diagnostic radiopharmaceuticals play an essential role, and an increasingly more sophisticated one, in understanding the disease state for many difficult-to-diagnose illnesses, including Alzheimer's disease, Parkinson's disease, initial and recurrent prostate cancer," the MITA stated, in comments submitted September 11 to the CMS.

Currently, the CMS bundles payments for PET imaging radiopharmaceuticals as part of the packaged cost of imaging procedures in hospital outpatient settings, and this policy remains in the agency's hospital outpatient prospective payment system (HOPPS) proposed rule for calendar year 2024.

The CMS has requested feedback on potential modifications to the current packaging policy, with the MITA taking the lead on behalf of nuclear medicine advocates to encourage CMS to implement separate payment requirements for diagnostic radiopharmaceuticals.

"CMS's decision to 'policy package' diagnostic radiopharmaceuticals creates a disincentive for hospitals with outpatient imaging service lines to utilize the most innovative diagnostic radiopharmaceuticals because they are not adequately reimbursed through the OPPS, which impacts patient care," the MITA wrote.

Changing the coverage has proponents in Congress, namely House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) and Subcommittee on Health Chair Brett Guthrie (R-KY), who held a subcommittee hearing this week to discuss current legislative proposals to improve access specifically for seniors to innovative drugs, medical devices, and technology.

Among legislation on the table was the Facilitating Access to Innovative Diagnostics (FIND) Act, a law that would direct the U.S. Department of Health and Human Services in fact to establish separate payment requirements for diagnostic radiopharmaceuticals.

The FIND Act was reintroduced in the U.S. Senate in May.

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