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Twenty Organizations Ask Medicare to End Coverage Restrictions for Alzheimer’s Disease Diagnostics

Published July 15, 2022

The Alliance, alongside 19 additional patient advocacy organizations, submitted comments today to the Centers for Medicare and Medicaid Services (CMS) regarding the agency’s coverage reconsideration for diagnostic tests for Alzheimer’s disease. Currently, Medicare beneficiaries are only permitted a single Beta Amyloid Positron Emission Tomography (PET) test per lifetime to test for dementia and neurodegenerative disease.

PET scans have become vital in accurately diagnosing Alzheimer’s disease. Evaluation through PET imaging has become central to patient diagnosis and is commonly used in clinical trials to assess the progression of the disease and to identify patients that may benefit from treatment. Just as importantly, PET imaging allows providers to rule out Alzheimer’s disease for beneficiaries that have symptoms consistent with the disease, but for whom amyloid-beta plaques are not present. For these individuals, a amyloid beta PET scan can prevent inappropriate treatment.

In the letter, the organizations ask CMS to end the one scan per lifetime limit, as well as end coverage restrictions that limit access to the use of PET scans to diagnose and monitor the progression of Alzheimer’s disease. Previously, CMS instituted coverage restrictions due in part to the absence of FDA-approved therapeutics to modify or delay the progression of the disease. However, with one disease-modifying drug since approved and others likely to be considered for approval soon, it is appropriate for CMS to remove these restrictions.

The comment letter can be read here.

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