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Assessing a Landmark Change in CMS Reimbursement for Diagnostic Radiopharmaceuticals
In an interview, SNMMI president Cathy Cutler, PhD, discussed the impact of the recent CMS decision to unbundle reimbursement for diagnostic radiopharmaceuticals costing above $630 a day, calling it a “game changer” decision that will benefit patients, physicians, and the development of new radiopharmaceutical agents.
While it took over a decade of advocacy to lead to the recent decision by the Centers for Medicare and Medicaid Services (CMS) to unbundle reimbursement for diagnostic radiopharmaceuticals exceeding $630 in per-day costs, the new policy significantly expands access to these modalities, according to Cathy Cutler, Ph.D., the president of the Society for Nuclear Medicine and Molecular Imaging (SNMMI).
“By CMS agreeing to walk away from bundling and to provide appropriate reimbursement (for diagnostic radiopharmaceuticals), this means that these important tools that physicians use to help ensure patients are getting optimal treatment will now be widely available,” noted Dr. Cutler in a recent interview.
Dr. Cutler said the shift away from bundling diagnostic radiopharmaceuticals as supplies and providing separate reimbursement for these modalities that exceed the daily cost threshold of $630 is a significant advance.
The policy, which goes into effect on January 1, 2025, will likely spur the development of new radiopharmaceuticals, according to Dr. Cutler, the Director of the Medical Isotope Research Production and Development Group in Brookhaven National Laboratory in New York.
While the new CMS policy was preceded by years of advocacy efforts from SNMMI, Dr. Cutler said the broader access to diagnostic radiopharmaceuticals is rewarding as it can lead to improved decision-making in the treatment of patients.
(Editor’s note: For related content, see “New SNMMI President Cathy Cutler, PhD, Discusses Current Challenges and Goals for Nuclear Medicine,” “What SPECT/CT May Reveal About Early Treatment Response for Pluvicto in Patients with mCRPC” and “FDA Clears Automated Dosimetry with the Monte Carlo Method for Radionuclide Therapy.”)
“I'm very happy for patients. I do think that these are very valuable tools that physicians get to use to help (patients) have optimal treatment and improves their quality of life. It can lead to extension of life, and it can ensure that they're not taking drugs that are not benefiting them, so I think this is a real win for patients,” emphasized Dr. Cutler.
For more insights from Dr. Cutler, watch the video below.
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