U.S. Senate lawmakers are asking federal officials to revisit a nine-year-old Medicare determination that severely limits coverage of diagnostic brain scans for dementia.
Currently, Medicare will cover one amyloid positron emission tomography (PET) scan per lifetime while the patient is enrolled in certain clinical studies. With new evidence supporting the efficacy of these scans for dementia diagnoses, Sens. Kevin Cramer (R-ND) and Edward Markey (D-MA) called for coverage that would support expanded patient access and encourage clinicians to use this technology.
A deterrent for clinicians
PET scans are very expensive, costing thousands of dollars out of pocket, the lawmakers wrote in a letter to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services. When clinician specialists determine that an accurate diagnosis requires a scan, only patients who can afford it or who are able to enroll in a clinical trial will get one, they noted.
“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,” they told HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure.
At the time of its original 2013 coverage decision, CMS determined that the evidence associating amyloid brain plaques and dementia was not yet strong enough to warrant greater coverage of the scans.
“In light of new research showing the effectiveness of this imaging technology, we support reconsideration of the [national coverage determination] and urge CMS to update it to improve access to this evidence-based diagnostic tool,” the senators said.
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