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CMS Proposes Removal of National Coverage Determination for Beta Amyloid PET
July 18, 2023
SNMMI applauds the recent proposal of the Centers for Medicare & Medicaid Services (CMS) to remove the national coverage determination (NCD) for beta amyloid PET, ending the coverage with evidence development (CED) requirements and allowing Medicare administrator contractors (MACS) to determine appropriate coverage for these scans.
“SNMMI is delighted that CMS is planning to allow coverage for beta amyloid PET imaging at the discretion of Medicare contractors,” said SNMMI president Helen Nadel, MD, FRCPC, FSNMMI. “Amyloid PET scans are an essential tool for effectively staging and managing the treatment of patients with Alzheimer’s and other dementias—and specifically for selecting patients for new FDA-approved anti-amyloid drugs, such as lecanamab, and determining if therapy has been effective. This decision would help ensure that this important nuclear medicine test is accessible to all patients who can benefit from it.”
Previously, CMS only allowed one beta amyloid PET scan per lifetime for Medicare recipients. Often scans were performed to determine the presence of amyloid plaques, which would fulfill the requirements to receive treatment; however, no additional scans could be performed to assess whether the treatment was working. Under the new CMS policy, patients would be able to seek reimbursement for multiple scans to determine whether Alzheimer’s treatments are effective.
This comes on the heels of the U.S. Food and Drugs Administration’s approval of lecanemab and will benefit patients undergoing other clinical trials for other monoclonal antibodies to treat Alzheimer's disease. The proposed removal of the NCD reflects CMS’ commitment to improving the diagnosis and treatment of Alzheimer’s disease.
SNMMI has worked for years in support of better coverage for beta amyloid PET scans. The society and its leadership have met with CMS many times over the years and have submitted comments to urge policymakers to remove the national coverage determination. SNMMI is also urging Congress to pass the FIND Act, bipartisan legislation that will improve access to innovative radiopharmaceuticals.
Alzheimer’s disease affects more than six million Americans and ranks as the sixth leading cause of death among U.S. adults. In 2022, the economic impact of Alzheimer’s disease on the American economy was estimated at $321 billion.