I 
116TH CONGRESS 
1ST SESSION H. R. 3772 
To amend title XVIII of the Social Security Act to ensure equitable payment 
for, and preserve Medicare beneficiary access to, diagnostic radiopharma-
ceuticals under the Medicare hospital outpatient prospective payment 
system. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 16, 2019 
Mr. PETERS (for himself, Mr. RUSH, and Mr. HOLDING) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to ensure 
equitable payment for, and preserve Medicare beneficiary 
access to, diagnostic radiopharmaceuticals under the 
Medicare hospital outpatient prospective payment system. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Diagnostic 
Radiopharmaceutical Payment Equity Act of 2019’’. 
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SEC. 2. SEPARATE PAYMENT FOR CERTAIN DIAGNOSTIC 
RADIOPHARMACEUTICALS. 
(a) IN GENERAL.—Section 1833(t)(16) of the Social 
Security Act (42 U.S.C. 1395l(t)(16)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(G) SEPARATE
PAYMENT
FOR
CERTAIN 
DIAGNOSTIC RADIOPHARMACEUTICALS.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
any other provision of this subsection, with 
respect to services furnished on or after 
January 1, 2020, the Secretary shall not 
package, and shall make a separate pay-
ment as specified in clause (ii) for, a diag-
nostic 
radiopharmaceutical 
defined 
in 
clause (v) with an estimated mean per day 
product cost equal to or exceeding the 
threshold specified in clause (iii). 
‘‘(ii) SEPARATE PAYMENT.—For pur-
poses of clause (i), payment specified in 
this clause for a diagnostic radiopharma-
ceutical described in clause (i) shall be 
equal to— 
‘‘(I) the average sales price for 
the drug established under section 
1847A, to the extent the average sales 
price is available, as calculated and 
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adjusted by the Secretary to the ex-
tent such adjustment is adopted for 
other specified covered outpatient 
drugs under paragraph (14)(A); or 
‘‘(II) if the data necessary to cal-
culate the average sales price for the 
drug in the year under the sections 
specified in subclause (I) is not avail-
able, the wholesale acquisition cost as 
defined in subsection 1847A(c)(6)(B), 
or, if the wholesale acquisition cost is 
not available, the mean unit cost data 
derived from hospital claims data. 
‘‘(III) Nothing in this subpara-
graph shall be construed as affecting 
eligibility of diagnostic radiopharma-
ceuticals for pass-through payments 
under paragraph (6). 
‘‘(iii) THRESHOLD.—For purposes of 
this subparagraph, the threshold specified 
in this clause— 
‘‘(I) for 2020, is $500; and 
‘‘(II) for subsequent years, is the 
amount specified in this clause for the 
preceding year increased by the per-
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centage of the OPD fee schedule in-
crease 
factor 
under 
paragraph 
(3)(C)(iv) for the applicable year. 
‘‘(iv) 
BUDGET
NEUTRALITY.—The 
Secretary shall make such adjustments as 
are necessary under subparagraph 9(B) to 
ensure that the amount of expenditures 
under this subsection for such year with 
application of this subparagraph is equal 
to the amount of expenditures that would 
be made under this subsection for such 
year without application of this subpara-
graph. 
‘‘(v) DEFINITION.—For purposes of 
this subparagraph, a diagnostic radio-
pharmaceutical is a drug or biological that 
is described in section 315.2(a) of title 21, 
Code of Federal Regulations, or any suc-
cessor regulation, and is approved by the 
Food and Drug Administration on or after 
January 1, 2008.’’. 
(b) NO IMPACT ON COPAYMENT.—Section 1833(t) of 
the Social Security Act (42 U.S.C. 1395l(t)(8)(E)) is 
amended by— 
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(1) inserting ‘‘AND SEPARATE PAYMENTS 
FOR CERTAIN DIAGNOSTIC RADIOPHARMA-
CEUTICALS’’ after ‘‘PASS–THROUGH ADJUST-
MENTS’’; and 
(2) inserting after ‘‘such adjustments)’’ the 
phrase ‘‘and subparagraph (16)(G)’’. 
Æ 
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