The Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2023 has been introduced by Reps. Neal Dunn (Florida), Scott Peters (California), Greg Murphy (North Carolina) and Terri Sewell (Alabama) as House Resolution 1199. Senators Marsha Blackburn (Florida) and Tammy Baldwin (Wisconsin) reintroduced the FIND Act in the Senate as Senate Bill 1544.
The Society of Nuclear Medicine and Molecular Imaging, the driving force behind this initiative, states that conditions such as Alzheimer’s and Parkinson’s disease, advanced cardiac disease, and cancers of the prostate, breast and brain continue to exact a heavy toll on elderly Americans. Medicare’s current reimbursement structure limits patient access to innovative imaging tools that improve diagnosis of these deadly diseases. These imaging tools provide previously unavailable information to support changes in patient management. Literature has demonstrated that the use of innovative imaging tools leads to more appropriate treatment and reduces the use of unnecessary treatments that may be expensive and debilitating.
Under the Medicare Modernization Act of 2003, radiopharmaceuticals were classified as stand-alone drugs and paid separately from the nuclear medicine procedure; however, in 2008, the Center for Medicare and Medicaid Services interpreted the Medicare Modernization Act as expired and began bundling payments into ambulatory classifications. However, the bundled payment fails to adequately cover the costs for both the procedure and diagnostic radiopharmaceutical impeding patients access to care.
Currently, CMS considers diagnostic radiopharmaceuticals as supplies through a packaged payment system, which creates a significant barrier to patient access to the newer, more precise generation of diagnostic nuclear imaging drugs. This methodology averages the higher cost of these specialized products with more general and widely used low-cost radiopharmaceuticals. The result is that the CMS policy overpays for the low-cost products and reduces reimbursement for the higher-cost products to such a point where providers simply choose not to provide these services.
As a result, the current policy fails to control costs and denies Medicare beneficiaries access to the newer, more precise generation of diagnostic imaging agents.
Reimbursing appropriately for newer, more advanced diagnostic radiopharmaceuticals would align with CMS reimbursement policy for many other drugs — including those in the Outpatient Prospective Payment System and radiopharmaceuticals in the Medicare Physician Fee Schedule. Removing higher-cost radiopharmaceuticals from the packaging system would also correct some of the current overpayment for the high-volume, lower-cost radiopharmaceuticals.
Directing Health and Human Services to pay separately for all diagnostic radiopharmaceuticals with a cost threshold of $500 per day means providers can better manage costs while also delivering more targeted and cost-efficient care.