Jay Reinstein, who has Alzheimer’s disease, sits up in bed after undergoing a PET scan at MedStar Georgetown University Hospital in Washington, DC, on June 20, 2023.
Michael Robinson Chavez | Michael Robinson Washington Post | Getty Images
Medicare plans to expand coverage of PET scans used to help diagnose Alzheimer’s disease, a major policy shift that could make it easier for patients to access new treatments entering the U.S. market.
The proposal would repeal Medicare’s current nationwide policy. Currently, the program for older adults only covers once-in-a-lifetime PET scans for patients participating in clinical trials.
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The Medicare proposal would allow regional groups called Medicare administrative contractors to decide whether to cover diagnostic tools.These regional contractors make coverage decisions based on whether the service is “reasonable and necessary” for the diagnosis of the disease.
Chiquita Brooks-LaSure, head of the Centers for Medicare and Medicaid Services, said in a statement Monday, proposed policy “Fulfilling CMS’ commitment to make this diagnostic test more widely available.” It was unclear when the decision on the PET scan would be finalized.
PET scans are an important diagnostic tool that can detect amyloid in the brain associated with Alzheimer’s disease. Scanning is the most common method used to help diagnose patients.
general health insurance Pay 20% The cost of a PET scan after the deductible has been met. A single scan costs about $313 per patient, according to estimates from a study published in May in the medical journal JAMA Internal Medicine.
Medicare coverage for PET scans should make it easier for patients to access new treatments, such as Leqembi, which the U.S. Food and Drug Administration approved earlier this month.
Medicare has agreed to cover Eisai and Biogen’s Alzheimer’s drug Leqembi, but requires patients to be diagnosed with mild cognitive impairment or mild Alzheimer’s and have starch in the brain Documented evidence of a protein-like protein.
Most patients choose a PET scan to confirm the presence of amyloid because imaging is less invasive than other diagnostic tools such as spinal taps.A blood test is also in development, Some of these are already in limited use but not yet widely available.
Medicare says it will also cover other Alzheimer’s antibody treatments for the same condition, if approved by the FDA. Eli Lilly The FDA is expected to make a decision on its treatment, donanemab, by the end of the year.
The Alzheimer’s Association, a lobby group that advocates for people with the disease, said the new policy proposed by Medicare would remove unnecessary barriers for patients. Maria Carrillo, the association’s chief scientific officer, called the decision “an important step forward.”