Telix Pharmaceuticals welcomes proposed changes announced by the Centers for Medicare & Medicaid Services (CMS) for the Hospital Outpatient Prospective Payment System (OPPS) rule to improve payments for diagnostic radiopharmaceuticals for Medicare patients in the United States (U.S.), facilitating continued patient access after transitional pass-through payment status expires.

Under the proposed changes, diagnostic radiopharmaceuticals including Illuccix® will continue to be paid separately by CMS for traditional Medicare Fee for Service patients in the hospital outpatient setting following the expiry of transitional pass-through payment status. This would also apply to new diagnostic products being developed by Telix, if approved.

Currently in the U.S., the costs associated with diagnostic radiopharmaceuticals are packaged together into the payment for the nuclear medicine tests (scans). The CMS is proposing refinements to this policy to improve the accuracy of overall payment amounts by paying separately for any diagnostic radiopharmaceutical with a per day cost greater than US$630.

Kevin Richardson, CEO of Telix Americas commented: "Telix welcomes the proposed rule, which will facilitate more equitable and reliable access to advanced imaging for all patients and support physicians to prescribe the most clinically appropriate solution. We commend the vision of CMS and the coalition, along with patient groups, for raising awareness about the necessity to reform the payment system to enhance patient outcomes and access. Telix is committed to continued innovation in the field of radiopharmaceutical diagnostics to provide new solutions to further patient access, especially for underserved patient populations and in areas of high unmet clinical need."

Proposed OPPS rules are published annually and have a 60-day comment period, which will end on 9 September 2024. The final rule will be issued in early November 2024 and take effect 1 January 2025.