New CMS Proposal to Improve Medicare Payments for Diagnostic Radiopharmaceuticals

Key Changes in Medicare Payments for Diagnostic Radiopharmaceuticals

The Centers for Medicare & Medicaid Services (CMS) have proposed changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) to improve payments for diagnostic radiopharmaceuticals. These changes aim to ensure continued patient access to these important diagnostic tools even after the transitional pass-through payment status expires.

Under the new proposal, diagnostic radiopharmaceuticals like Telix's Illuccix® will continue to receive separate payments from CMS for traditional Medicare Fee for Service patients in hospital outpatient settings. This also extends to new diagnostic products that are developed and approved in the future.

Impact on Patient Access and Physician Practices

Currently, the cost of diagnostic radiopharmaceuticals is bundled into the payment for nuclear medicine tests. The new CMS proposal aims to refine this policy by paying separately for radiopharmaceuticals with a per day cost exceeding $630. This change will improve the accuracy of payment amounts and support equitable and reliable access to advanced imaging.

Kevin Richardson, CEO of Telix Americas, mentioned that the proposed rule will enable physicians to prescribe the most clinically appropriate imaging solutions for their patients. He emphasized that the reform is crucial for enhancing patient outcomes and access, especially for underserved populations.

Timeline for Implementation

The proposed OPPS rules are published annually and include a 60-day comment period, which will end on September 9, 2024. The final rule is expected to be issued in early November 2024 and will come into effect on January 1, 2025.

These changes signify a critical step in the ongoing efforts to improve the healthcare system and ensure that patients have access to the latest and most effective diagnostic tools.

About Telix Pharmaceuticals

Telix Pharmaceuticals Limited is a biopharmaceutical company dedicated to developing and commercializing therapeutic and diagnostic radiopharmaceuticals. Headquartered in Melbourne, Australia, Telix operates internationally, with offices in the United States, Europe, and Japan.

Telix's flagship imaging product, Illuccix®, has received approval from the U.S. Food and Drug Administration (FDA), the Australian Therapeutic Goods Administration (TGA), and Health Canada. The company continues to focus on addressing significant unmet medical needs in oncology and rare diseases.

For more information about Telix and its innovative products, visit their official website and follow them on social media platforms like X and LinkedIn.

This update has been authorized for release by the Telix Pharmaceuticals Limited Disclosure Committee on behalf of the Board.