I 
115TH CONGRESS 
2D SESSION 
H. R. 6948 
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 
SEPTEMBER 27, 2018 
Mr. HOLDING (for himself and Mr. MOULTON) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee 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 2018’’. 
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SEC. 2. SEPARATE PAYMENT FOR CERTAIN DIAGNOSTIC 
RADIOPHARMACEUTICALS. 
Section 1833(t)(16) of the Social Security Act (42 
U.S.C. 1395l(t)(16)) is amended by adding 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, 2019, the Secretary shall not 
package, and shall make a separate pay-
ment as specified in clause (ii) for, a diag-
nostic radiopharmaceutical with an esti-
mated 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 price for the drug 
in the year under the sections speci-
fied in subclause (I) is not available, 
the average acquisition cost for the 
drug for that year (which, at the op-
tion of the Secretary, may vary by 
hospital group (as defined by the Sec-
retary based on volume of covered 
OPD services or other relevant char-
acteristics)), as determined by the 
Secretary taking into account the hos-
pital acquisition cost survey data 
under paragraph (14)(D). 
‘‘(iii) THRESHOLD.—For purposes of 
this subparagraph, the threshold specified 
in this clause— 
‘‘(I) for 2019, 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 this subsection, with 
respect to a year, to ensure that the 
amount of expenditures under this sub-
section 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 appli-
cation of this subparagraph. 
‘‘(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.’’. 
Æ 
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