A bipartisan group of lawmakers in the House of Representatives and Senate have introduced legislation that would modify how Medicare reimburses providers for treatments using diagnostic radiopharmaceuticals (RPs). Currently, diagnostic RPs are packaged as “supplies” under the Hospital Outpatient Prospective Payment System (HOPPS).

The Facilitating Innovative Nuclear Diagnostics (FIND) Act would require CMS to adopt a separate payment policy under HOPPS for RPs brought to market after 2008 that exceed the cost of $500 per day. The current Medicare payment system averages the cost of newer and more costly RPs with more commonly used and less expensive versions of the treatments. Advocates, such as the Society of Nuclear Medicine & Molecular Imaging (SNMMI), argue that the current payment methodology for RPs limits access to the newer, more effective treatments for chronic diseases by incentivizing providers to choose the lower cost and potentially less effective treatments.

It is important to consider that the bill requires CMS to implement the new payment structure in a budget-neutral manner, meaning these changes would lead to reduced reimbursement for those lower cost Radiopharmaceuticals and potentially impact reimbursement in other areas of HOPPS.

This is the second iteration of the FIND Act, first introduced in the last Congress. SNMMI and other proponents are hoping that a grassroots effort across the imaging space could lead to a more successful outcome for the legislation this session.

It is unlikely that Congress will act on this as a stand-alone bill, but if proponents are able to emphasize the bill’s ability to control overall costs in the Medicare program and improve clinical outcomes for patients, it is not out of the realm of possibility that this proposal be included as a “policy-rider” in a year-end appropriations package.

AHRA has not formally taken a position on this legislation. However, if you are interested in contacting your federal representatives in Congress about this legislation, you can utilize SNMMI’s grassroots advocacy tool.