May 15, 2020
This week SNMMI and its coalition partners sent a letter imploring Congress to take immediate action to ensure patient access to FDA-approved diagnostic radiopharmaceutical drugs that aid in the detection of cancer, cardiovascular conditions and neurological disorders. Mounting evidence shows that COVID-19 infection damages not only the respiratory system but the heart and other organ systems—and the long-term effects of this disease are still unknown. Patients who survive COVID-19 will need access to the best care available, and nuclear medicine is an essential part of that care.
COVID-19 has imposed an enormous burden on the healthcare system, and the same holds true for the field of nuclear medicine. Imaging departments and practices have seen volume decreases of as much as 70% since the pandemic began. Now, as hospitals begin to reopen for non-emergent elective procedures, they will need to struggle meet the demand to diagnose heart disease, cancer, neurological and other conditions that have gone undiagnosed and untreated over the past few months. In addition, infection control for imaging services will increase overall costs—putting further stress on available resources.
Nuclear medicine was already facing significant reimbursement challenges that hindered patient access to innovative, precision diagnostic drugs and limited the ability of new, more effective diagnostic imaging technologies to penetrate the market. Since 2008, the Centers for Medicare and Medicaid Services (CMS) has been treating diagnostic radiopharmaceuticals as supplies, bundling or “packaging” the drugs with the cost of the procedure. Often the reimbursed rate for the entire bundle is lower than the cost of the innovative diagnostic radiopharmaceutical drug, which results in underpayments to hospitals.
SNMMI and its coalition partners have been working with patient groups to support the “Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019” (H.R. 3772), which would safeguard access to the most appropriate diagnostic radiopharmaceuticals and encourage innovation and development of additional imaging drugs that will be used in the future to improve patient care. With the enhanced financial pressure on hospitals from the COVID-19 pandemic, we are concerned hospitals will be reluctant to fully support innovative nuclear medicine services because of inadequate reimbursement due to existing Medicare policy payment methodologies.
More than 20 million Americans benefit annually from nuclear medicine procedures—precision medicine that allows diagnosis and treatment to be tailored to individual patients in order to achieve the best possible outcomes. Therefore, as Congress contemplates additional support for the American healthcare system, they must also ensure that patients continue to have access to the most effective diagnostic drugs available today.