spawns Shares of Lantheus Holdings ( NASDAQ: LNTH ) climbed on Wednesday after the Centers for Medicare and Medicaid Services (CMS) issued a draft proposal to improve payments for diagnostic radiopharmaceuticals. The Bedford, Massachusetts-based radiopharma company’s leading revenue generators include Pylarify, a prostate cancer diagnostic imaging agent, and Definity, a diagnostic ultrasound-enhancing agent. CMS' proposal applicable for 2025 calendar year follows a review of Medicare payment rates for hospital outpatient and ambulatory surgical center services.
According to the current coverage policy, diagnostic radiopharmaceuticals used for outpatient therapy are included with nuclear medicine tests for reimbursement. “We recognize that in some specific circumstances, the payment amount for the nuclear medicine tests may not adequately account for the cost of certain specialized diagnostic radiopharmaceuticals,” CMS said. Under the new CMS proposal, any diagnostic radiopharmaceutical with a per-day cost exceeding $630 will be paid separately and no longer included under the nuclear medicine tests.
“This update should address challenges for patients in accessing these prescribed nuclear medicine tests with higher-cost radiopharmaceuticals,” the agency noted. The proposed rule will have a 60-day comment period until September 9 , 2024, after which the CMS will publish the final rule in early November. More on Lantheus Leading The Growth Of Radiopharmaceuticals: Mini.
