CMS Outlines Proposed Coverage for Alzheimer’s Screening Test

The Centers for Medicare and Medicaid Services has specified it will provide some coverage for a potential Alzheimer’s test, although not yet widespread.

The test includes beta-amyloid imaging; a PET scan, drug administration and doctor’s interpretation, not yet proven sufficient to improve health outcomes for Medicare beneficiaries with dementia or neurodegenerative disease, CMS says. But there are some instances where it is helpful in ruling out Alzheimer’s and therefore, there are certain cases where coverage should be provided to patients.

“…there is sufficient evidence that the use of PET Aβ imaging could be promising in two scenarios,” CMS wrote in a July 3 proposal, noting the imagining can be used to exclude Alzheimer’s disease in narrowly defined and clinically difficult differential diagnoses; and to enrich clinical trials seeking better treatments or prevention strategies for Alzheimer’s, by allowing for selection of patients on the basis of biological as well as other factors.

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CMS is proposing covering one scan per patient under Medicare, for patients who meet certain criteria, outlined by the agency. The proposal was met with opposition from the makers and marketers of the technology, as well as the Alzheimer’s Association

“The Alzheimer’s Association is disappointed by the Centers for Medicare & Medicaid Services (CMS) draft coverage decision on brain amyloid imaging, particularly given the clear, scientific consensus recommendations provided to CMS by the Association and the Society for Nuclear Medicine and Molecular Imaging (SNMMI) regarding appropriate, limited coverage, only in specific populations,” the association said in a statement.

Noting the number of older people who are affected by Alzheimer’s disease today, the association urged CMS to consider the acute need for testing and said it will continue to work with CMS in the interim following the proposed rule.

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“With 5 million Americans living with Alzheimer’s and more than 15 million people providing care, the need to accelerate improved care and an early and accurate diagnosis today, when scientifically supported, is critical,” the Association stated.

Written by Elizabeth Ecker

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