Medicare proposes removing limit on PET scans used to help diagnose Alzheimer's disease

Medicare plans to grow its sum of PET scans that are utilized to assistance diagnose Alzheimer's disease, a large displacement successful argumentation that could marque it easier for patients to entree caller treatments that are entering the U.S. market.

The connection would abolish Medicare's existent nationwide policy. Right now, the programme for seniors volition lone screen 1 PET scan per beingness for patients participating successful objective trials.

The Medicare connection would let determination organizations, called Medicare Administrative Contractors, to determine whether to screen the diagnostic tool. These determination contractors marque sum decisions based connected whether a services is "reasonable and necessary" for the diagnosis of an illness.

Chiquita Brooks-LaSure, caput of the Centers for Medicare and Medicaid Services, said successful a connection Monday that the proposed policy "fulfils CMS' committedness to let broader sum of this diagnostic test." It is inactive unclear erstwhile the determination connected PET scans volition beryllium finalized.

PET scans are a important diagnostic instrumentality that observe an amyloid macromolecule connected the encephalon that is associated with Alzheimer's disease. The scans are the astir communal method to assistance diagnose patients.

People connected Medicare mostly pay 20% of the outgo of a PET scan aft gathering their deductible. The outgo of a azygous scan would travel to astir $313 per patient, according to 1 estimation successful a May survey published successful the aesculapian diary JAMA Internal Medicine.

Medicare sum of PET scans should marque it easier for patients to entree caller treatments specified arsenic Leqembi, which was approved by the Food and Drug Administration earlier this month.

Medicare has agreed to screen Eisai and Biogen's Alzheimer's attraction Leqembi, but it requires patients to beryllium diagnosed with mild cognitive impairment oregon mild Alzheimer's illness with documented grounds of amyloid connected the brain.

Most patients opt for PET scans to corroborate amyloid beingness due to the fact that the imaging is little invasive than alternate diagnostic tools specified arsenic spinal taps. Blood tests are besides successful development, with immoderate already successful constricted use, but they person not been broadly rolled retired yet.

Medicare has said it volition besides screen different Alzheimer's antibody treatments with the aforesaid conditions if they person support from the FDA. Eli Lilly expects the FDA to marque a determination connected its treatment, donanemab, by the extremity of the year.

The Alzheimer's Association, the lobbying radical that advocates for radical surviving with the disease, said the caller argumentation projected by Medicare would region unnecessary barriers for patients. Maria Carrillo, the association's main technological officer, called the determination a "major measurement forward."