CMS To Pay For BETA-Amyloid PET Scans Which Are Required Prior To Starting A Patient On Any Alzheimer’s Disease Treatment Drugs
October 13, 2023
The Centers for Medicare & Medicaid Services (CMS) announced today that it would begin paying for the beta-amyloid PET scans which are required prior to starting a patient on any Alzheimer’s treatment drugs.
This historic decision expands access to this vital nuclear medicine test for patients with Alzheimer's disease and other neurodegenerative diseases. The decision eliminates previous Coverage with Evidence Development requirements, allowing Medicare Administrative Contractors to determine appropriate coverage for these scans.
Amyloid PET scans are the gold standard for confirming amyloid presence in the brain, offering critical insights that influence treatment and quality-of-life decisions.
This decision will be beneficial for patients receiving monoclonal antibody treatments for Alzheimer's disease. To ensure appropriate administration of these new drugs, SNMMI recommends amyloid PET scans to confirm the presence of amyloid plaque buildup in the brain. PET scans should also be performed during treatment to monitor reduction in amyloid plaque levels. CMS previously permitted only a single beta-amyloid PET scan per lifetime for Medicare recipients.
Alzheimer's disease affects more than six million Americans and ranks as the sixth leading cause of death among American adults. In 2022, the economic impact of Alzheimer's disease on the U.S. economy was estimated at $321 billion.
