Medicare Panel’s Failure to Recommend Payment for New Alzheimer’s Diagnostic Brain Imaging Scans

PET amyloid imaging scans can promote early diagnosis, appropriate treatment and care management that improve quality care for Alzheimer's and other dementias

Howard Fillit, MD, founding Executive Director and Chief Science Officer of the Alzheimer's Drug Discovery Foundation and George Vradenburg, Chairman of USAgainstAlzheimer's today issued a joint statement in response to an advisory opinion last week by the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) that there is insufficient evidence to support Medicare reimbursement for PET amyloid imaging scans in patients with cognitive impairment being evaluated for Alzheimer's disease.

The Administration has a goal of preventing and effectively treating Alzheimer's by 2025. A failure to reimburse for diagnostic procedures for the early detection and accurate diagnosis of Alzheimer’s disease will have significant negative consequences in our fight to effectively treat and manage people with dementia.

Medicare coverage of innovative PET amyloid scans can help a physician rule out a diagnosis of Alzheimer's disease in individuals with cognitive impairment who might otherwise retreat from active life and receive unnecessary treatments while saving the patient and their loved ones months or years of unnecessary anxiety," Fillit and Vradenburg said.

It is often difficult for a physician to accurately diagnosis Alzheimer's disease in its earliest stages. Many people with cognitive problems who do not have Alzheimer's have a good prognosis, and can get better with lifestyle interventions and appropriate medical treatment for medical comorbidities such as hypertension.

On the other hand, a positive PET amyloid scan in people with mild cognitive impairment can accelerate early and accurate diagnosis, leading to appropriate use of FDA medications that are safe and effective for Alzheimer's disease, as well as the extremely necessary care management and advanced care planning services which are critical to the cost-effective management of these complex patients.

They added: "As we confront a dementia tsunami, we hope that CMS will recognize the important value of early diagnostic tools for Alzheimer's and other dementias. CMS has set precedent and previously done so in its approval for payment of FDG-PET scans to diagnose frontotemporal dementia. The same criteria should be used for PET amyloid neuroimaging. We urge the CMS to follow previous precedents in national coverage for FDGPET scan for individuals with dementia who may have FTD, and provide national coverage of PET amyloid brain neuroimaging. By doing so, CMS will fulfill its commitment to the goal of preventing and effectively treating Alzheimer's and other dementias by 2025.

The MEDCAC concern regarding excess, unnecessary or inappropriate utilization of the PET amyloid imaging scans is unwarranted in our opinion. Payers including Medicare already have effective utilization management strategies for the use of FDG-PET scans for the diagnosis of the cause of dementia which can be further applied and revised as necessary for PET amyloid neuroimaging. The guidelines recently published by the Amyloid Imaging Task Force are a good starting point.

By failing to provide coverage for dementia diagnostic procedures, CMS will suppress innovation and research in the field. Absent appropriate coverage and payment of dementia diagnostic procedures, patients with Alzheimer’s disease and related dementias will not be able to receive early and accurate diagnosis that, like in other chronic diseases, can lead to appropriate and cost–effective, quality treatment and care management that can improve the quality of life and outcomes for patients, their loved ones and caregivers."