Medicare coverage for Alzheimer’s PET scans in doubt after high-profile, $100M study misses its mark

Whether Medicare will cover costly positron emission tomography scans to diagnose Alzheimer’s disease is in doubt after a high-profile, $100 million study on the practice produced mixed results.

The analysis was sponsored by the American College of Radiology and included more than 25,000 Medicare beneficiaries, with researchers exploring whether PET diagnosis could curb costs. But the effort fell short of its goal of cutting hospitalizations by 10% in the first year following a scan.

Rates among patients imaged with PET landed at 24%, compared to 25% among those who did not undergo such testing, researchers revealed at the online Alzheimer’s Association International Conference that wraps up July 31. However, among the scanned group, those with Alzheimer’s did tally fewer hospitalizations when compared to those without the brain disease, the Associated Press reported Thursday.

With PET scans costing upward of $5,000—and researchers moving closer to a cheaper blood test alternative—the findings cast doubt on PET’s possible use in regular clinical care. Private insurers are also reportedly watching the results closely.

It’s a very fair question: Why should we even do this testing?” Suzanne Schindler, MD, a neurologist with Washington University in St. Louis who enrolled patients in the study, asked the AP.

The Alzheimer’s Association also sponsored the study alongside ACR and other imaging companies. Medicare, meanwhile, helped design the analysis and paid for it. A CMS spokesman said that a formal request would need to be filed for the agency to reconsider its 2013 decision to not cover the scans in most cases. Advocates argue that Alzheimer’s PET is worthwhile, even if it does not save money, while the college also emphasized that the results are only preliminary. 

"We look forward to reading the final paper—and using this data and others to inform our Medicare payment dialogue with CMS moving forward," Cynthia Moran, ACR's executive VP of government relations and health policy, told Radiology Business Friday. 

Read more from the AP below.