January 2020 ~

The year-end spending bill package signed, last month, by the president will provide billions in funding toward research that’s key to radiologists’ work. The bill package, H.R. 1865, will provide $41.7 billion to the National Institutes of Health (NIH) as well as provides $338 million to the Agency for Healthcare Research and Quality to support NIH research initiatives.

The funds are being allocated, as follows, to provide additional support the following NIH research initiatives:

• $500 million for ‘All of Us’ precision medicine research
• $500 million for Brain Research through Application of Innovative Neurotechnologies
• $195 million for Cancer Moonshot
• $50 million for Childhood Cancer Data Initiative

The spending packages also included a provision to restore and extend pass-through payment status for two radiopharmaceutical drugs used in the Imaging Dementia—Evidence for Amyloid Scanning (IDEAS) Study.

The study, managed by the American College of Radiology^® (ACR^®), assesses whether, in diagnostically uncertain cases, amyloid PET imaging can help guide clinicians with care planning to attain better health outcomes for patients with mild cognitive impairment, dementia and/or Alzheimer’s disease.

The initial IDEAS Study utilized three PET imaging drugs that received “pass-through” payment status as part of the trial’s “coverage with evidence development” design. The initial pass-through designation expired for one of the relevant drugs in 2017. The designation ended for the other two in 2018.

Language included in the 2018 fiscal year (FY18) omnibus appropriations bill extended the pass-through payment status for only one of the relevant three IDEAS Study drugs, which consequently created a payment disparity that could impact New IDEAS, the forthcoming second phase of the study. The payment disparity then led to hospitals using the one pass-through drug receiving approximately three times more reimbursement than facilities using either one of the other drugs and bundled payments resulted in a significant monetary loss per procedure.

The American College of Radiology (ACR) government relations team, after discovering the payment disparity, collaborated with various stakeholders to create a solution to re-establish pass-through for the two omitted drugs by re-establishing the pass-through payment status through October 1, 2020.

Source(s): Radiology Business; American College of Radiology; American College of Radiology;