Jay Reinstein, who suffers from Alzheimer’s disease, sits on his bed after having a PET scan at MedStar Georgetown University Hospital in Washington, DC June 20, 2023.
Michael Robinson Chavez | Washington Post | Getty’s paintings
Medicare plans to expand the range of PET scans which might be used to diagnose Alzheimer’s disease, a major policy change that might make it easier for patients to access latest treatments entering the US market.
The proposal would abolish the present nationwide Medicare policy. Currently, the senior program will only have one PET scan per life for patients participating in clinical trials.
The Medicare proposal would allow regional organizations, called Medicare Administrative Contractors, to make a decision whether or to not cover the diagnostic tool. These regional contractors make coverage decisions based on whether the services are “reasonable and essential” to diagnose the condition.
Chiquita Brooks-LaSure, head of the Centers for Medicare and Medicaid Services, said in a statement Monday that proposed policy “meets the commitment of CMS to permit wider coverage of this diagnostic test.” A CMS spokesman said a final decision might be made inside 90 days.
PET scans are a key diagnostic tool that detects the amyloid protein within the brain that’s related to Alzheimer’s disease. Scans are probably the most common method to assist diagnose patients.
People on Medicare on the whole pay 20% PET scan costs after meeting their deductible. The price of a single scan could be around $313 per patient, in response to estimates from a May study published within the medical journal JAMA Internal Medicine.
Dr Sean Tunis, former medical director at CMS, said it was possible regional contractors would make different decisions concerning the scope of PET testing. But these organizations generally work together on major issues, and there is not any reason to imagine their policies on PET scans will vary significantly across america, said Tunis, who’s now a consultant at Rubix Health.
Medicare’s coverage of PET scans should make it easier for patients to access latest treatments like Leqembi, which was approved by the Food and Drug Administration earlier this month.
Medicare has agreed to cover Eisai and Biogen Leqembi’s Alzheimer’s treatment costs, but requires patients to be diagnosed with either mild cognitive impairment or mild Alzheimer’s disease with documented evidence of amyloid within the brain.
Most patients decide to have a PET scan to verify the presence of amyloid because imaging is less invasive than alternative diagnostic tools resembling a lumbar puncture. Blood tests are also being developed and a few are already in limited use but haven’t yet been widely deployed.
Medicare said it can also cover other Alzheimer’s antibody therapies under the identical conditions in the event that they receive FDA approval. Eli Lily expects the FDA to make a decision on its treatment, donanemab, by the top of the 12 months.
The Alzheimer’s Association, a lobby 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 scientific director, called the choice “a big step forward.”