An imaging industry advocate is blasting the Centers for Medicare & Medicaid Services’ failure to address PET coverage gaps in a recent ruling.
The agency revealed its final payment policy for controversial Alzheimer’s drug aducanumab (brand name Aduhelm) on Thursday, April 7, limiting coverage to government-approved clinical trials. “To the disappointment of many,” the decision included no added coverage for beta-amyloid PET imaging, used to detect such plaques in the brain, the Society for Nuclear Medicine & Molecular Imaging said Friday.
Instead, CMS will keep its current policy, only paying for these scans as required by clinical trials, limited to one per patient per lifetime. Meanwhile, other beta-amyloid tests such as cerebral spinal fluid sampling are covered without limitations, despite PET serving as the standard of care, the group said.
“We are disappointed that in its final decision, CMS did not modify its original proposed coverage of one beta-amyloid PET scan per person per lifetime,” SNMMI said in its April 8 statement. “We expressed our strong opposition to this proposal. There is no evidence to suggest that a single amyloid PET scan per patient is appropriate or that a scan performed years ago can provide the diagnostic information needed to determine whether a patient is currently a candidate for therapy.”
SNMMI believes, instead, that the agency should allow for as many PET scans as needed, granting physicians with ample information to determine decisions on therapy. The Reston, Virginia-based association said it is “equally concerned” that CMS declined to remove or retire the current beta-amyloid PET national coverage determination. Paying for the scans outside of clinical trials could help determine patients’ eligibility for these studies and alleviate anxiety around testing a treatment that may not benefit them, the society said.
“Having access to amyloid PET before participating in a registry or randomized trial would help assure more equal access of patients to anti-amyloid therapies,” SNMMI concluded. “We will continue to work for broad national coverage of amyloid PET scans by either a positive NCD or through Medicare Administrative Contractor discretion.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.