A group of U.S. senators is pushing for the Centers for Medicare and Medicaid Services to revise their coverage determination pertaining to amyloid positron emission tomography (PET) scans used to diagnose various forms of dementia. 

As it stands, CMS covers just one of these scans per patient per lifetime, and that coverage is contingent upon patients being enrolled in certain clinical trials. This national coverage determination (NCD) was made in 2013.  

At that time, there was limited evidence to suggest an association between amyloid deposits and Alzheimer’s disease, which is what prompted CMS to limit coverage of the scan. However, since then numerous clinical studies have produced ample evidence of the effectiveness of these scans in the diagnosis and management of Alzheimer’s disease—something that the lawmakers suggest warrants reconsideration of the final decision. 

“Despite the new evidence that amyloid PET imaging is effective, current Medicare coverage restrictions create access barriers for patients and providers may be discouraged from including amyloid PET scans ‘as part of standard clinical practice,’” the lawmakers wrote in a letter to CMS and the Department of Health and Human Services. “Amyloid PET scans cost thousands of dollars out of pocket, so even if a health care provider who specializes in dementia determines that a patient’s accurate diagnosis requires a scan, only those who can afford it or can enroll in a clinical trial will get one.”