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Medicare Coverage Of Amyloid PET Scans In Alzheimer’s Expected To Be ‘Consistent,’ Even Without National Standard, CMS Says

 
• By Cathy Kelly

Medicare has finally rescinded its 10-year-old national restrictions on covering the diagnostic now that advances in amyloid plaque-removing drugs have underscored the importance of PET scans.

Development Will Advance Uptake Of Treatment • Source: Shutterstock

The Centers for Medicare and Medicaid Services is retiring its Medicare national coverage determination restricting coverage of amyloid PET scans for Alzheimer’s and dementia patients to use in clinical trials, and will allow its Medicare Administrative Contractors to establish coverage policy on a regional basis going forward, according to a final decision released by the agency on 13 October.

Key Takeaways

  • Medicare is lifting the restrictions on coverage of amyloid PET scans, but declined to establish a new policy mandating broad coverage.

  • Stakeholders are already pressing Medicare Administrative Contractors for unrestricted coverage

The decision also removes the one scan per patient per lifetime requirement in the NCD. The action confirms the proposed decision issued by CMS in July, and removes a significant obstacle to broader access to drug treatments for Alzheimer’s disease

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