Prominent imaging society advocates for 5 changes following CMS amyloid PET payment decision
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has responded to a decision by the Centers for Medicare and Medicaid Services (CMS) regarding its coverage of amyloid PET scans utilized for the treatment of Alzheimer’s.
On Jan. 11, CMS announced that monoclonal antibody therapy directed against amyloid for the treatment of Alzheimer’s Disease (AD) would be paid for under coverage with evidence development (CED). This ruling requires that individuals participate in clinical trials as a condition of payment.
In response, SNMMI released a statement Feb. 17 advocating for the expanded coverage and reimbursement of amyloid PET by highlighting the following five considerations:
CMS should cover an amyloid PET scan before a patient is considered eligible for a CMS-approved study. SNMMI argues that amyloid PET can rule out patients for the antibody treatment before the study, and that CMS should, therefore, cover the exam when clinicians are determining whether patients qualify for the trial.
CMS should not finalize a limit of one beta amyloid PET scan per lifetime. There is no proof that outdated scans offer diagnostic-quality information that could decipher if patients would respond to antibody therapy, the society suggested, citing that central nervous system beta-amyloid status can fluctuate over time.
CMS should require post-treatment PET to be performed as needed to document the removal of beta amyloid from the brain. To make informed decisions and establish that trials are reliable, physicians should be able to obtain as many PET scans as they deem clinically necessary. Additionally, one or more scans are needed to ensure the removal of amyloid.
CMS should retire the current PET CED in conjunction with finalizing the monoclonal antibody national coverage determination. Limiting amyloid PET coverage while PET is utilized for other AD treatments creates confusion for physicians, patients and trial designers, which could complicate enrollments, the statement implied.
CMS should not limit sites of service for approved clinical trials to hospitals. Such restrictions could create access difficulties for trial participants and would exacerbate health disparities, SNMMI suggested.
You can view the full statement on SNMMI.org.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.