Jay Reinstein, who suffers from Alzheimer’s, sits on a mattress after receiving a PET scan at MedStar Georgetown University Hospital in Washington, DC on June 20, 2023.
Michael Robinson Chávez | The Washington Post | Getty Images
Medicare plans to increase its protection of PET scans which are used to assist diagnose Alzheimer’s illness, a serious shift in coverage that would make it simpler for sufferers to entry new remedies which are getting into the U.S. market.
The proposal would abolish Medicare’s present nationwide coverage. Right now, this system for seniors will solely cowl one PET scan per lifetime for sufferers collaborating in scientific trials.
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The Medicare proposal would permit regional organizations, known as Medicare Administrative Contractors, to resolve whether or not to cowl the diagnostic device. These regional contractors make protection selections primarily based on whether or not a providers is “reasonable and necessary” for the prognosis of an sickness.
Chiquita Brooks-LaSure, head of the Centers for Medicare and Medicaid Services, mentioned in a press release Monday that the proposed coverage “fulfils CMS’ commitment to allow broader coverage of this diagnostic test.” It remains to be unclear when the choice on PET scans will probably be finalized.
PET scans are an important diagnostic device that detect an amyloid protein on the mind that’s related to Alzheimer’s illness. The scans are the most typical technique to assist diagnose sufferers.
People on Medicare typically pay 20% of the price of a PET scan after assembly their deductible. The price of a single scan would come to about $313 per affected person, in accordance with one estimate in a May research revealed within the medical journal JAMA Internal Medicine.
Medicare protection of PET scans ought to make it simpler for sufferers to entry new remedies akin to Leqembi, which was accredited by the Food and Drug Administration earlier this month.
Medicare has agreed to cowl Eisai and Biogen’s Alzheimer’s therapy Leqembi, but it surely requires sufferers to be recognized with gentle cognitive impairment or gentle Alzheimer’s illness with documented proof of amyloid on the mind.
Most sufferers go for PET scans to verify amyloid presence as a result of the imaging is much less invasive than various diagnostic instruments akin to spinal faucets. Blood checks are additionally in growth, with some already in restricted use, however they haven’t been broadly rolled out but.
Medicare has mentioned it is going to additionally cowl different Alzheimer’s antibody remedies with the identical situations in the event that they obtain approval from the FDA. Eli Lilly expects the FDA to decide on its therapy, donanemab, by the tip of the 12 months.
The Alzheimer’s Association, the lobbying group that advocates for folks dwelling with the illness, mentioned the brand new coverage proposed by Medicare would take away pointless boundaries for sufferers. Maria Carrillo, the affiliation’s chief scientific officer, known as the choice a “major step forward.”
Source: www.cnbc.com”