In a letter to CMS Acting Administrator Elizabeth Richter, Reps. Scott Peters (D-CA) and Bobby Rush (D-IL) said the current method of automatically including newer, often lower-volume, higher-cost precision diagnostic radiopharmaceuticals into procedure amounts fundamentally does not work. The cost of these radiopharmaceuticals often significantly exceeds the cost of the packaged procedure reimbursement.
Peters and Rush said the current methodology has created a disincentive for hospitals to use the most appropriate diagnostic drugs.
CMS has treated diagnostic radiopharmaceuticals as ancillary supplies to procedures since 2008. Despite lobbying efforts last year from the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and other patient and provider groups, CMS rejected a recommendation to unpack diagnostic radiopharmaceuticals in its 2021 Final Rule.
This year, a coalition that includes the SNMMI is working to introduce a new bill to address the problem called the Facilitating Innovative Nuclear Diagnostics Act of 2021.
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