Jay Reinstein, who suffers from Alzheimer’s, sits on a bed after receiving a PET scan at MedStar Georgetown University Hospital in Washington, DC on June 20, 2023.Â
Michael Robinson Chávez | The Washington Post | Getty Images
Medicare plans to expand its coverage of PET scans which might be used to assist diagnose Alzheimer’s disease, a serious shift in policy that might make it easier for patients to access recent treatments which might be entering the U.S. market.
The proposal would abolish Medicare’s current nationwide policy. At once, this system for seniors will only cover one PET scan per lifetime for patients participating in clinical trials.
The Medicare proposal would allow regional organizations, called Medicare Administrative Contractors, to determine whether to cover the diagnostic tool. These regional contractors make coverage decisions based on whether a services is “reasonable and crucial” for the diagnosis of an illness.
Chiquita Brooks-LaSure, head of the Centers for Medicare and Medicaid Services, said in an announcement Monday that the proposed policy “fulfils CMS’ commitment to permit broader coverage of this diagnostic test.” A final decision could are available 90 days, a CMS spokesperson said.
PET scans are an important diagnostic tool that detect an amyloid protein on the brain that’s related to Alzheimer’s disease. The scans are probably the most common method to assist diagnose patients.
People on Medicare generally pay 20% of the fee of a PET scan after meeting their deductible. The fee of a single scan would come to about $313 per patient, based on one estimate in a May study published within the medical journal JAMA Internal Medicine.
Dr. Sean Tunis, former chief medical officer at CMS, said it is feasible that the regional contractors could give you different coverage decisions for PET scans. But these organizations generally work together on major issues and there is not reason to think their policies on PET scans would vary widely across the U.S., said Tunis, who’s now a consultant at Rubix Health.
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Medicare coverage of PET scans should make it easier for patients to access recent treatments resembling Leqembi, which was approved by the Food and Drug Administration earlier this month.
Medicare has agreed to cover Eisai and Biogen’s Alzheimer’s treatment Leqembi, however it requires patients to be diagnosed with mild cognitive impairment or mild Alzheimer’s disease with documented evidence of amyloid on the brain.
Most patients go for PET scans to verify amyloid presence since the imaging is less invasive than alternative diagnostic tools resembling spinal taps. Blood tests are also in development, with some already in limited use, but they’ve not been broadly rolled out yet.
Medicare has said it’s going to also cover other Alzheimer’s antibody treatments with the identical conditions in the event that they receive approval from the FDA. Eli Lilly expects the FDA to make a call on its treatment, donanemab, by the top of the yr.
The Alzheimer’s Association, the lobbying group that advocates for people living with the disease, said the brand new policy proposed by Medicare would remove unnecessary barriers for patients. Maria Carrillo, the association’s chief scientific officer, called the choice a “major step forward.”
