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CMS Removes NCD for Beta Amyloid PET
October 13, 2023
The Centers for Medicare & Medicaid Services (CMS) announced today the removal of the National Coverage Determination (NCD) for beta-amyloid PET scans, expanding 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.
“SNMMI applauds CMS for recognizing the pivotal role of amyloid PET scans in effectively managing Alzheimer's and other dementias,” said SNMMI president Helen Nadel, MD, FRCPC, FSNMMI. "This decision ensures increased accessibility to this crucial nuclear medicine test for eligible patients and facilitates the targeted use of new treatments for those who can benefit."
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.
SNMMI has advocated for improved coverage of beta-amyloid PET scans over the years, engaging with CMS and providing consistent input to encourage removal of the National Coverage Determination. 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.
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.
SNMMI is now urging CMS to retire or eliminate other outdated PET National Coverage Determinations that inappropriately restrict coverage. In addition, the society is calling on Congress to pass the FIND Act, bipartisan legislation aimed at enhancing access to innovative radiopharmaceuticals.