Medicare won’t cover PET scans for dementia screenings

The agency overseeing the Medicare program has ruled the evidence is insufficient to support full coverage of advanced imaging tests to diagnose beneficiaries with dementia or neurodegenerative disease.

The Centers for Medicare & Medicaid Services published its decision in a July 3 draft memo stating that positron emission tomography amyloid-beta imaging does not improve health outcomes for Medicare patients. However, CMS has proposed to cover the scans for select patients participating in clinical studies as long as several conditions are met. The study objectives must be to develop better treatments or strategies to identify Alzheimer’s disease, or to resolve clinically difficult differential diagnoses, such as frontotemporal dementia versus Alzheimer’s.

The Medicare Evidence Development & Coverage Advisory Committee had held a Jan. 30 hearing on the PET screenings. Supporters testified about the benefits of obtaining a definitive diagnosis that, for example, would allow families and physicians to develop care plans early. However, the committee issued a recommendation to CMS against coverage because of a lack of evidence and studies about improved outcomes in such instances.

The Alzheimer’s Assn. said the draft memo is not final and proponents will continue to call for Medicare coverage for brain amyloid imaging.

“An early diagnosis has been found to lead to better outcomes and higher quality of life for people living with the disease and their families by: enabling earlier access to appropriate treatments, allowing the family to build a care team and seek out education and support services, enabling enrollment in Alzheimer’s/dementia clinical trials, and providing an opportunity for the development of advance directives and financial planning,” the association said in a statement. “We encourage CMS to have an open dialogue with all stakeholders in creating its final decision, so that the needs of all parties may be identified and taken into consideration.”