Legislation aims to improve patient access to diagnostic radiopharmaceuticals

July 17, 2019 | Michael Walter | Policy

Reps. Scott Peters, Bobby L. Rush and George Holding introduced a bipartisan bill this week that would increase patient access to key diagnostic radiopharmaceuticals used to help treat Alzheimer’s disease, Parkinson’s disease and numerous cancers. The Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 (HR 3772) is designed correct the limiting reimbursement structure currently in place for these radiopharmaceuticals. 

“In San Diego and across the country, health care innovation has allowed doctors to diagnose, monitor, and treat some of the most aggressive and least understood diseases,” Peters said in a prepared statement. “This bill will provide doctors with additional resources to diagnose Alzheimer’s, cancer, brain disorders, Parkinson’s disease, and other less-understood diseases. I thank my colleagues Rep. Rush and Rep. Holding for their commitment to providing better health care to Americans.”

“It is critical that patients have access to the health services they need to ensure they receive the right treatment at the right time,” Rush said in the same statement. “In my home state of Illinois, many hospitals have chosen, and are continuing to choose, not to provide access to diagnostic radiopharmaceuticals because Medicare reimbursement rates are lower than the cost to perform the test.”

Strong support from the imaging industry

A number of imaging groups have shown support for the new legislation. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) hosted a briefing on Capitol Hill on Wednesday, July 17, aimed at discussing why this bill is so important. 

“We’ve really only scratched the surface of potential with these technologies, and I expect we’ll see future improvements in these diagnostic tools if policy is adjusted to better reflect patient need,” said Vasken Dilsizian, SNMMI president, according to a prepared statement from the organization. 

SNMMI is also organizing a letter-writing campaign to help spread the word, asking others throughout “the nuclear medicine and molecular imaging community” to join in.

The Medical Imaging and Technology Alliance (MITA) issued its own statement in support of HR 3772. 

“Under the current Medicare Hospital Outpatient Prospective Payment System, cutting-edge, effective radiopharmaceutical drugs are inappropriately packaged, which limits patient access and discourages innovation,” Terri Wilson, senior director of patient access and healthcare policy at Blue Earth Diagnostics and chair of the MITA PET Group, said in a statement. “The Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 fixes this structural flaw, allowing patients much-needed access to diagnostic radiopharmaceuticals for life-threatening conditions.”

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