CMS to Relax Rules on PET Scans

The Centers for Medicare and Medicaid Services (CMS) announced this week that it would expand coverage for PET scans used in the diagnosis of Alzheimer’s disease.

CMS has been hesitant to open reimbursements for the procedure, and the agency has long said that it would only cover one brain scan per beneficiary for a patient’s lifetime, but only if that patient was also enrolled in a clinical trial for Alzheimer’s, Fierce Biotech reports. A PET scan is capable of finding clumps of beta amyloid proteins within the brain, which are associated with the onset of Alzheimer’s specifically and distinguishes the disease from other causes of dementia or memory loss.

Earlier this year, the U.S. Food and Drug Administration granted full approval to the anti-Alzheimer’s medication by Eisai and Biogen, Leqembi. Leqembi has demonstrated results in slowing the progression of beta amyloid protein buildup on the brains of patients, Axios explains. CMS later agreed to cover the drug if health providers agreed to collect and share data about the drug’s efficacy, but the once-in-a-lifetime rule for PET scans would hinder some patients from accessing the drug.

The Hill notes that until now, providers were also hindered from monitoring patients for potential side effects from the drug like brain swelling. Medicare beneficiaries usually pay roughly 20% of the cost of a PET scan after deductible. Advocacy groups like the Alzheimer’s Association applauded the agency’s decision.

From Maria Carrillo, chief science officer of the Alzheimer’s Association:

Broader access to amyloid PET scans will enable earlier and more accurate diagnosis, and better care management. Their use can lead to better health outcomes for people living with Alzheimer’s or another dementia.