DMS Blog

How Changes to Pass-Through Status Will Affect Precision Radiopharmaceuticals

Precision radiopharmaceutical diagnostic imaging procedures help identify abnormalities early in the progress of a disease —before many medical problems are apparent with other diagnostic tests.

Despite the proven effectiveness of radiopharmaceuticals, such as Axumin and NETSPOT, countless patients are limited in their access because of Medicare’s flawed payment system.

Changes to pass-through status will result in patients who are unable to access these advanced diagnostic procedures. Let’s take a closer look at pass-through status and how you can get involved.

What is Pass-Through Status and Why Does it Matter?

Pass-through status is a transitional period of two to three years during which CMS allows for separate payment of diagnostic radiopharmaceuticals.

Initially, Medicare separately reimburses hospitals for the new radiopharmaceuticals. At the end of the “pass-through” period, Medicare then “packages” them with the older, lower cost radiopharmaceuticals and the procedure costs.

The result is that healthcare providers– who are already financially strapped due to the COVID-19 pandemic–are forced to make the choice of taking a financial loss or stop offering the procedure, even though the less expensive alternatives may not provide the needed diagnosis.

As a result, patients are losing access to these imaging procedures, which may be vital for diagnosis, treatment planning and maintaining their health.

Josh Mailman wrote about this issue in a piece for The Hill. When he was diagnosed with a pancreatic neuroendocrine tumor in 2007, he was fortunate enough to have the resources to be able to travel and pay for innovative diagnostic imaging. As he acknowledges, most Americans are not in this position.

“When it comes at the expense of patients like me who face life-threatening diseases, we have a problem that needs to be fixed. Diagnostic tests that are less accurate can lead to less optimal treatment decisions. America’s patients deserve a health care system that supports and encourages access to innovative imaging techniques.”

Of course, when talking about conditions such as cancer, early diagnosis and appropriate treatment are crucial for improving patient outcomes. From a cost perspective, too, earlier diagnosis can shorten the length and depth of treatment, resulting in lower overall costs.

How You Can Get Involved

Congress can fix this issue and protect access to these precision diagnostics by passing H.R. 3772, the Medicare Diagnostic Radiopharmaceutical Payment Equity Act, which would reform the Medicare payment system to ensure that hospitals are appropriately paid when providing advanced nuclear imaging services.

Change can happen, but we all need to speak up for Congress to fully understand what is at stake. You can quickly and easily send a letter to Congress by visiting the Right Scan Right Time website.

Take five-minutes, write to your lawmakers, and urge them to support this important legislation.

Ready to get Started?