Radiopharmaceutical Medicare Use Jumps: ASTRO Abstracts Outline Delivery Models

Growth in spending on radiopharmaceuticals has prompted the need to develop clinical pathways for their delivery in both academic and community settings. Authors presented studies on these topics Tuesday and Wednesday at the first-ever Multidisciplinary Radiopharmaceutical Therapy (RPT) Symposium, organized by the American Society for Radiation Oncology (ASTRO) in Palm Desert, California.

Radiopharmaceuticals are used in cancer and other diseases target delivery of radionuclides for both diagnosis and treatment. In cancer care, radioligand therapy combines a radioisotope with a ligand, which binds the agent to markers on specific cancer cells. Radioligands can offer options in refractory tumor types that do not respond to existing treatments, such as prostate cancer.

Growth in Medicare

An abstract presented at ASTRO’s symposium by authors from City of Hope found that annual intravenous RPT administrations in Medicare Part B rose from 529 in 2013 to 12,395 by 2023, representing more than a 20-fold increase. In 2023, diagnostic radiology/interventional radiology accounted for 45.2% of all IV/RPT services, nuclear medicine, 36.6%; radiation oncology, 15.3%; and medical oncology, 2.5%.¹

“Growth occurred across all specialties, with evolving relative participation patterns over time. These findings highlight the expanding modern multidisciplinary footprint of RPT delivery in the US, characterized by substantial absolute growth across specialties and shifting participation patterns,” wrote the authors, led by Sean Maroongroge, MD, MBA, radiation oncologist at City of Hope in Duarte, California. “This reinforces the importance of continued cross-disciplinary planning to address research, credentialing, regulatory, and workflow needs to advance the field of RPT moving forward.”¹

Guidance for programs

Abstracts presented at the symposium outlined how to establish high-quality RPT programs in both academic and community settings.^2,3

Seema Kacker, MD, PhD, of Johns Hopkins School of Medicine, presented information on the health system’s RPT program, which is presented at 4 locations in Maryland and Washington, DC. Patients receive treatments for conditions that include prostate cancer and neuroendocrine tumors and can take part in clinical trials.² The Department of Radiation Oncology manages 3 sites, and the Division of Nuclear Medicine and Molecular Imaging in Radiology manages 1 site.

For each Johns Hopkins location, patients receive screening for clinical eligibility and financial clearance; if cleared, treatments are scheduled and ordered from the vendor, with RPT administration overseen by an authorized user (AU) in the consulting department. The provider team manages patient education, safety precautions, and all follow-up.

The positive elements of this approach include high-quality care, access to novel RPT agents across hospital and ambulatory settings, extension of the health system’s geographic reach, and increased patient access. The downside of this parallel model is the duplication of infrastructure and staff efforts across the 2 management units.

“Each department has streamlined RPT processes and standard operating procedures,” the authors wrote. “However, by operating within separate channels of supply and workflow, this approach may not be taking advantage of potential economies of scale, shared infrastructure, shared staffing or other operational synergies.”²

Daniel Sforza, laboratory manager for Johns Hopkins Department of Radiation Oncology and Molecular Radiation Sciences, discussed a second abstract on processes needed to ensure safety in a community setting not initially designed to administer radiopharmaceuticals.³

“One of the most challenging aspects of implementing RPT was finding a location to satisfy radiation safety regulations and an efficient workflow,” the authors wrote. The clinic offers Lu-177-PSMA-617 (Pluvicto; Novartis) and Radium-223 dichloride (Xofigo; Bayer). As the authors explained, gamma decay and increased activity created several additional requirements for patients receiving Pluvicto, including a dedicated bathroom located close by, which was determined with the assistance of the radiation safety officer. Authors outlined precise steps for receiving and calibrating doses in the hot lab, ensuring patients used the dedicated restroom instead of a public restroom, and proper cleaning of the area.

Over a 16-month period ending in October 2025, the site treated 12 patients with Xofigo and 28 with Pluvicto. “Our workflow enables us to meet current demand by treating up to 3 patients in a half-day session, twice weekly,” the authors wrote.

Pathways for RPT

Other abstracts dealt with how to place radiopharmaceuticals into clinical pathways and scale their administration to fit into workflows. For Intermountain Health, which operates across a large geographic area, one issue with these therapies has been the need for both radiation oncologists (ROs) and nuclear medicine (NMs) physicians to be designated as AUs. Intermountain needed to create a model that equally distributed AU duties, which would improve access to Pluvicto for metastatic castrate-resistant prostate cancer (mCRPC) while ensuring quality.⁴

A focus group of RO, NM, and medical oncology physicians gathered to discuss specifics for developing the RPT model for patients receiving Pluvicto for mCRPC. The group determined that the AU role would be driven by disease volume at presentation and the potential need for external beam radiation (EBRT). RO was AU for patients who either had low-volume/oligometastatic disease or could benefit from EBRT. NM treated all other patients. Prior to RPT implementation, all Pluvicto cases were covered by RO.

An RPT-specific tumor board was created to handle cases and divide AU responsibilities. As more rural RPT sites of care joined the system, more RO than NM physicians were available to deliver therapy, although NM physicians are still being sought.⁴

Another abstract evaluated prototype testing of bidirectional data exchange for a research partnership between Miami Cancer Institute (MCI) and its industry partner in RPT delivery.⁵ At MCI, the authors state, RPT is implemented within RO under an APEx-accredited framework, using a multidisciplinary model; RO takes the lead, joined by NM and MO. RPT therapies administered include iodine-131 (I-131), Xofigo, lutetium-177 (Lutathera), and emerging actinium-225 (Ac-225) and lead-212 (Pb-212) therapies. An audit identified inefficiencies in scheduling, documentation, and workflows. According to the abstract, a software prototype was developed with modular functionality for “registration, consultation, authorization, radiopharmaceutical ordering, infusion coordination, laboratory trending, and follow-up.”

The new system allows bidirectional communication through the electronic medical record and oncology information systems through Health Level Seven (HL7) standards to align patient, order, and appointment data. This has allowed both sides to retrieve imaging data, allowing for lesion identification, treatment-response analysis, and other capabilities. The design can handle both RO and NM models and supports combination therapies, the authors stated. Although the system is still in prototype evaluation, it has shown the capacity to support an artificial intelligence (AI)-based platform to unify all documentation.

“The integrated collaboration system establishes a validated, adaptable digital framework for RPT workflows,” the authors wrote.

References

1. Maroongroge S, Sampath S, Williams TM, et al. Multispecialty expansion in radiopharmaceutical therapy: national trends in Medicare from 2013-2023. Presented at: Multidisciplinary Radiopharmaceutical Therapy Symposium, American Society for Radiation Oncology (ASTRO); February 17-18, 2026; Palm Desert, CA. Abstract 11.
2. Kacker S, Hobbs RF, ShupeEM, et al. A model of parallel radiopharmaceutical therapy delivery in one large academic health system. Presented at: Multidisciplinary Radiopharmaceutical Therapy Symposium, American Society for Radiation Oncology (ASTRO); February 17-18, 2026; Palm Desert, CA. Abstract 13.
3. Sforza D, Knight JA, Lin L, et al. Challenges establishing a radiopharmaceutical therapy clinic within a radiation oncology department in a community-based hospital. Presented at: Multidisciplinary Radiopharmaceutical Therapy Symposium, American Society for Radiation Oncology (ASTRO); February 17-18, 2026; Palm Desert, CA. Abstract 17.
4. Gravbrot N, Hu E, Maughan NM, etal. A Multidisciplinary Care Process Model for Radiopharmaceutical Therapy including Both Radiation Oncologists and Nuclear Medicine Physicians as Authorized Users. Presented at: Multidisciplinary Radiopharmaceutical Therapy Symposium, American Society for Radiation Oncology (ASTRO); February 17-18, 2026; Palm Desert, CA. Abstract 14.
5. Tolakanahalli RP, Lin T, Kalman NS, et al. From Concept to Clinic: Development and Prototype Implementation of the Intelligent Radiotherapy Collaboration System for Integrated Radiopharmaceutical Workflows. Presented at: Multidisciplinary Radiopharmaceutical Therapy Symposium, American Society for Radiation Oncology (ASTRO); February 17-18, 2026; Palm Desert, CA. Abstract 16.