Ensured that specialized imaging drugs are properly reimbursed under Medicare
SERVICE: Policy Development, Political Counseling
AREA OF EXPERTISE: Healthcare
- CMS had proposed reclassifying radiopharmaceuticals used in nuclear medicine so that they are no longer considered “drugs” under Medicare. As a result of this change, CMS would no longer provide separate payment for radiopharmaceuticals in the hospital outpatient setting, but bundle these drugs into the payment for nuclear medicine procedures.
- Devised and implemented a lobbying effort focused on the House Ways and Means, Energy and Commerce, and Senate Finance Committees to educate them on the history behind the treatment of radiopharmaceuticals as “drugs,” as well as the significant adverse impact such a change would have on Medicare beneficiaries’ access to these products. Working with manufacturers, health care providers, patient groups and other stakeholders, we enlisted the support of Members of Congress on the relevant committees of jurisdiction for legislation that would preserve the treatment of radiopharmaceuticals as “drugs” under Medicare.
- Succeeded in having Congress include language in the Medicare Modernization Act providing that radiopharmaceuticals would continue to receive separate reimbursement in the outpatient setting.