ADVOCACY UPDATE: House Committee Passes 'FIND Act,' Which Would Change How Some Radiopharmaceuticals Are Reimbursed

Last week, the U.S. House of Representatives Committee on Energy & Commerce passed H.R. 1199, the Facilitating Innovative Nuclear Diagnostics (FIND) Act. If signed into law, the bill would require separate payment of radiopharmaceuticals with a mean per-day cost exceeding $500 under the Hospital Outpatient Prospective Payment System. Radiopharmaceuticals such as Tc-99m and Rb-82 would stay bundled into the procedure payment because their per-day costs are under the $500 threshold.
During the Energy & Commerce Committee hearingRep. Neal Dunn (R-FL), the bill's sponsor, emphasized that the bill would create increased access to life-saving technologies for Medicare beneficiaries. Committee Ranking Member Rep. Frank Pallone (D-NJ) spoke about ensuring the bill would not increase beneficiaries' out-of-pocket costs and expressed interest in receiving a cost analysis from the Congressional Budget Office. Rep. Brett Guthrie (R-KY) also spoke in support of the bill. 

Background: In 2023, the Centers for Medicare & Medicaid Services (CMS) sought feedback on its current packaging policy for radiopharmaceuticals. CMS specifically asked for input on the advisability of a separate payment for radiopharmaceuticals above a per-day cost threshold of $140 (or some other per-day threshold). In comments submitted to CMS, ASNC emphasized the importance of fully understanding the implications of the proposed policy change on nuclear medicine ambulatory payment classifications (APCs) and potential cuts in reimbursement before moving forward with changes. (For background on how APCs work, view ASNC's Health Policy 101 video "Ambulatory Payment Classifications and Your Reimbursement.")

Now What? The next step for the FIND Act is consideration by the full House of Representatives. The bill currently has 41 cosponsors. It is important to note that CMS has the authority to change the current packaging policy without passage of the FIND Act; however, the House's consideration of the bill could put pressure on CMS to act.