Older adults covered by Medicare now will have expanded access to Alzheimer’s diagnostic scans — and by extension, possible treatments.
The Centers for Medicare & Medicaid Services changed its coverage policy to remove certain restrictions on who can get amyloid PET scans. CMS now will allow regional contractors to approve multiple PET scans for people who possibly have Alzheimer’s, the agency announced Friday.
Before then, Medicare covered only one PET scan during a patient’s lifetime, and limited certain drug coverage to those enrolled in clinical studies.
The new allowance comes at a time when several new drug options to treat Alzheimer’s, such as Leqembi, are hitting the market.
“We believe removal of [the previous restrictions] will allow appropriate coverage of amyloid PET scans and will greatly reduce provider and patient burden from the existing requirements and test limitation,” CMS decision memo authors state. “As new treatments, or other new technology, are developed and approved, Medicare Administrative Contractors are able to promptly respond to the evidence on proven treatments for individual patients.”
Since the restrictions were first put in place in 2013, improved understanding of Alzheimer’s risk factors and progression, as well as updated standards of care, has led to treatment options that can prevent or delay up to 40% of cases, the CMS memo notes.
Alzheimer’s organizations lauded the CMS decision but also encouraged MACs not to limit coverage on their end.
“This decision reflects the FDA’s confidence in this technology after many years of evaluation,” Alzheimer’s Association Chief Science Officer Maria Carrillo said in a statement. “It is essential that the MACs continue the CMS practice of covering PET scans in support of treatment.”
Although the decision was effective as of Friday, it may take some time for regional agencies to establish PET scan coverage protocols, one story noted.
Leqembi will be covered by Medicare, provided that the condition is first diagnosed in someone who has mild cognitive impairment or Alzheimer’s, which the PET scans could demonstrate. CMS updated its Alzheimer’s drug coverage policy over the summer, following the Food and Drug Administration’s clearance for Leqembi in July.