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Amyloid PET Scan Coverage Approved at Last

Amyloid Scans diagnose and treat Alzheimer's, at a hefty price. 11 years after FDA approval, Medicare can finally help.
Photo Of Man Sitting On A PET Scanner — Clinical care for Alzheimer’s disease is undergoing a sea change. The latest wave? Eleven years after the first amyloid PET tracer was approved by the U.S. Food and Drug Administration, the scans will be broadly covered for Medicare beneficiaries. Previously, the Centers for Medicare and Medicaid Services had offered only “coverage with evidence development,” a program that restricted reimbursement to people participating in an approved clinical study. In addition, beneficiaries were limited to one scan per lifetime.

In an October 13 memo, CMS lifted the CED requirement and one-scan limit. This change allows regional Medicare administrators to make coverage decisions for amyloid PET as they do for other diagnostic tools. The agency noted that its decision was motivated by the approval of plaque-busting immunotherapies, since monitoring progress with these drugs may require multiple scans.

Alzheimer’s researchers hailed the news. “I welcome the CMS decision,” Steven Salloway at Butler Hospital in Providence, Rhode Island, wrote to Alzforum (comment below). “This should provide wider access for amyloid PET in clinical practice, opening the door for treatment with amyloid-lowering antibodies.” Gil Rabinovici at the University of California, San Francisco, led the largest amyloid PET CED study, IDEAS. He called the ruling a win. “This is an important milestone for the field,” he told Alzforum.

Extract. Read the full article on Alzforum: After a Decade, Amyloid PET Scans Receive Broad Insurance Coverage

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Maxine Brink
Maxine Brink
November 9, 2023 12:24 am

Thanks for the information on plaques.

B. Berger

B. Berger

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