Facilitating Innovative Nuclear Diagnostics (FIND) Act

Nuclear medicine scans are often the most effective AND cost-effective way to diagnose certain diseases, providing the best possible care for patients, but...

Patients lack access to nuclear medicine scans that could change the course of their treatment.
Physicians are less likely to administer a game-changing PET or other nuclear medicine scan because of lack of appropriate reimbursement.
Hospitals are facing the decision of discontinuing certain nuclear medicine procedures, because Medicare does not cover anywhere near full drug cost.
Companies that have innovated life-changing nuclear medicine drugs are having trouble keeping them in production and developing new ones.
Medicare is paying for unnecessary therapies, surgery, and hospital stays because it continues to treat these drugs as supplies and bundles them in with the scan.

The bi-partisan Facilitating Innovative Nuclear Diagnostics (FIND) Act will ensure patient access to these imaging procedures.
 








Bill Summary

Section 1. Short Title. Facilitating Nuclear Diagnostics Act of 2021
Section 2(a). Separate Payment for Certain Diagnostic Radiopharmaceuticals.

Section 2(a) would add a provision to Medicare’s Hospital Outpatient Prospective Payment System (OPPS system) to:

  • Direct the Secretary of Health and Human Services to pay separately under the OPPS system for diagnostic radiopharmaceuticals (Dx RPs) with an estimated mean per day product cost exceeding $500. The provision would take effect on or after January 1, 2020. In subsequent years, the threshold would increase by the inflation update CMS applies to outpatient department payments.
  • Establish reimbursement for eligible Dx RPs at the average sales price (ASP) for the drug, to the extent available. When ASP is not available, the Dx RP would be paid the wholesale acquisition cost (WAC) or, if WAC is not available, the mean unit cost data derived from hospital claims data.
  • Preserve transitional pass–through payment for additional costs of innovative Dx RPs under Section 1833(t)(6) of the Social Security Act.
  • Ensure that the Secretary implements separate payment in a budget neutral manner by harmonizing the cost of separate payment across the OPPS system.
  • Limit eligible Dx RPs to drugs approved by the Food and Drug Administration on or after January 1, 2008, the date that the Medicare program began bundling reimbursement for hospital outpatient procedures involving Dx RPs.

Section 2(b). No Impact on Copayment.
This section would ensure that Medicare beneficiaries will not incur an additional copayment obligation for separately paid Dx RPs.