June 7, 2018
Medicare patients with metastatic cancers may be negatively impacted by the recent decision of the Centers for Medicare & Medicaid Services (CMS) to decline to provide coverage for 18F-sodium fluoride positron emission tomography (NaF PET) imaging.
The Journal of Nuclear Medicine published analyses requested by CMS that demonstrated the use of NaF PET for detection of bone metastasis leads to changes in patient management and more appropriate curative or palliative care across the continuum of care for patients with cancer.
The World Molecular Imaging Society (WMIS), the American College of Radiology, the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and the members of the National Oncologic PET Registry (NOPR) Working Group urge CMS to open a reconsideration of the National Coverage Determination (NCD) for NaF PET, so that patients may receive this more appropriate care.
“The NOPR data clearly show that use of NaF PET led to more appropriate care for many cancer patients. We urge CMS to reconsider coverage for these potentially lifesaving and life-improving exams,” said NOPR principal investigator Dr. Bruce Hillner.
In December 2017, the NOPR Working Group formally submitted a request to CMS for reconsideration of the NCD for NaF PET. On May 9, 2018, CMS sent a letter to NOPR stating that the evidence was insufficient to support reconsideration – even though the findings of the NOPR research demonstrated that NaF PET results altered treatment plans and led to actual changes in care. This was the outcome predicted by NOPR and discussed with CMS.
“We are disappointed that CMS did not open a reconsideration and allow public comment on the published evidence to support coverage for NaF PET. Many cancer patients would be helped by CMS reconsidering coverage for these exams,” said NOPR co-chair Dr. Barry Siegel.
WMIS, ACR and SNMMI have collaborated with CMS and the NOPR to collect clinical utility data on NaF PET since 2011. During that time, the NOPR performed over 65,000 scans for Medicare beneficiaries. With the closure of the NOPR to patient accrual in December 2017, this vital imaging service is no longer covered for Medicare beneficiaries.
“Many seniors may ultimately receive care that is not as effective or helpful as it could be if CMS does not reconsider Medicare coverage for NaF PET. This is a step backwards in care for these patients. We urge CMS to reconsider coverage so that these seniors can have access to care that can better help them,” said NOPR co-chair Dr. Anthony Shields.
WMIS, ACR and SNMMI will continue to work with CMS to support Medicare coverage and beneficiary access to this important diagnostic tool.
ABOUT THE WORLD MOLECULAR IMAGING SOCIETY
The WMIS is dedicated to developing and promoting translational research through multimodality molecular imaging. The education and abstract-driven WMIC is the annual meeting of the WMIS and is held in conjunction with partner societies including the European Society for Molecular Imaging (ESMI) and the Federation of Asian Societies for Molecular Imaging (FASMI). WMIC provides a unique setting for scientists and clinicians with very diverse backgrounds to interact, present, and follow cutting-edge advances in the rapidly expanding field of molecular imaging that impacts nearly every biomedical discipline. Industry exhibits at the congress included corporations who have created the latest advances in preclinical and clinical imaging approaches and equipment, providing a complete molecular imaging educational technology showcase. For more information: www.wmis.org.
ABOUT THE SOCIETY OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and medical organization dedicated to advancing nuclear medicine and molecular imaging, vital elements of precision medicine that allow diagnosis and treatment to be tailored to individual patients in order to achieve the best possible outcomes.
SNMMI’s more than 16,000 members set the standard for molecular imaging and nuclear medicine practice by creating guidelines, sharing information through journals and meetings and leading advocacy on key issues that affect molecular imaging and therapy research and practice. For more information, visit www.snmmi.org.
ABOUT THE AMERICAN COLLEGE OF RADIOLOGY
The American College of Radiology, founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care.