America Wants Domestic Medical Isotopes. Can the Economics Work?

NorthStar showed that molybdenum-99 (Mo-99), the parent isotope of technetium-99m used in diagnostic imaging, could be produced in the United States. Then it said it couldn’t keep doing it profitably. That gap, between making the isotope and running a business that keeps making it, is now the central question for domestic supply.

SHINE is pursuing a different route with federal backing, and Medicare has added a payment incentive for qualifying domestic doses. Both are aimed at that gap. Neither settles who will pay enough, consistently enough, to keep production going.

NorthStar’s molybdenum-99 warning

The Department of Energy reported in 2021 that NorthStar had started domestic Mo-99 production in 2018 by irradiating molybdenum-98 rather than using highly enriched uranium. DOE also announced $37 million in cooperative-agreement funding to expand reactor-based production and develop an accelerator route.

Then, in October 2023, NorthStar told AuntMinnie, in response to the publication’s inquiry, that its Mo-99 program was no longer sustainable. Its chief executive pointed to rising raw-material, irradiation and processing costs, and to competition from foreign producers backed by government subsidies.

That’s the company’s explanation, not an audited cost comparison. Still, it names the problem NorthStar said it couldn’t solve. A working process hadn’t produced a sustainable business.

What SHINE’s molybdenum-99 loan commitment covers

On April 9, 2026, DOE announced a conditional loan commitment of up to $263 million for SHINE’s Chrysalis medical-isotope facility in Janesville, Wisconsin. DOE described a production approach using fusion and fission technology and put the project at 75% complete at the time.

The word “conditional” is doing real work there. DOE said technical, legal, environmental and financial conditions had to be met before definitive financing documents and funding. The announcement shows substantial federal backing for construction. It doesn’t show that the loan has closed, that commercial Mo-99 shipments have started, or that the plant’s operating economics will hold up.

The $10 incentive is now a finalized policy

On the purchasing side, CMS’s 2026 hospital outpatient payment final-rule fact sheet describes a $10 add-on per qualifying dose of Tc-99m derived from domestically produced molybdenum-99, starting January 1, 2026.

To qualify, at least half of the Mo-99 in the generator that produced the dose must be domestic. CMS also created code C9176 and framed the payment as recognition of the anticipated higher cost of domestic supply.

The money goes to providers, though, not isotope makers. Whether it shifts purchasing depends on which products qualify, what they cost and how the supply chain passes costs and payments along.

Construction support and operating demand

A loan helps build a plant. An add-on payment makes an eligible dose cheaper for the provider buying it. Neither tells you how much output customers will buy, or whether the producer’s revenue will cover operations, maintenance and financing costs.

That’s what to watch as domestic capacity comes online. Announced capacity is useful for planning. Regular deliveries, purchase commitments and evidence of sustainable costs would say more about whether it lasts.

None of the public announcements lay out comparable production costs or customer contracts for NorthStar and SHINE, so they can’t tell us whether SHINE’s different technology and financing will avoid NorthStar’s outcome or repeat it.

Domestic molybdenum-99 supply has a policy case. Whether it has a business case will show up in something plainer than an announcement: steady deliveries that customers keep ordering.