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Assessing the reimbursement challenges facing radiopharmaceuticals

by Gus Iversen, Editor in Chief | June 25, 2021
Molecular Imaging
Dr. Munir Ghesani
From the June 2021 issue of HealthCare Business News magazine

As with anything else in healthcare, access to radiopharmaceuticals depends on adequate reimbursement. Without that financial support, no matter how affective a treatment may be for a patient, providers are unable to offer them. These challenges are prevalent in nuclear medicine, but progress is being made.

We sat down with Dr. Munir Ghesani, chair of SNMMI’s Government Relations Committee and SNMMI vice president-elect, to talk about the state of reimbursement in nuclear medicine, and why it’s likely to be one of the most discussed topics at the society’s upcoming meeting.

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HCB News: Can you tell us a bit about your own background in medicine and how you became involved in the reimbursement side of healthcare?
Dr. Munir Ghesani: I have been practicing nuclear medicine in the academic setting for the past 25 years, with training and certification in internal medicine, nuclear medicine and radiology. I am actively involved in various societies and organizations. As the chair of the SNMMI Government Relations Committee for the past 9 years, I have been working with the SNMMI staff, members and industry partners. We collectively strive to create an awareness of the important role of diagnostic and therapeutic nuclear medicine in improving patient outcomes and would like to ensure appropriate reimbursement of nuclear medicine procedures. I am fortunate to have an excellent group of dedicated individuals with diverse backgrounds on the team. We all share a common goal of safeguarding the viability of our field so that we can continue to provide cutting-edge diagnostic and therapeutic procedures to our patients.

HCB News: The last time we spoke (2018), you explained how bundled payments for radiopharmaceuticals were hurting access to certain exams. Has there been any progress with that?
MG: SNMMI and our coalition partners, the Medical Imaging and Technology Alliance (MITA) and the Council on Radionuclides and Radiopharmaceuticals (CORAR), explained this issue to the U.S. Government Accountability Office (GAO) last year, and they listened. In their report, the GAO acknowledged that hospitals’ use of precision diagnostic radiopharmaceuticals was higher when drugs were eligible for the initial pass-through payments (i.e., under the HOPPS rule, the Centers for Medicare and Medicaid Services [CMS] initially pays separately for a diagnostic radiopharmaceutical at actual cost to the hospital for up to 3 years) than when they were eventually bundled with the scan.

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