Exciting News: Medicare Lifts PET Scan Restrictions for Revolutionary Alzheimer’s Drugs

Medicare to Expand Coverage for PET Scans in Alzheimer’s Diagnosis

Medicare will now provide broader access to PET scans, a valuable tool in diagnosing Alzheimer’s disease. The Centers for Medicare and Medicaid Services (CMS) announced in a recent memo that they would remove the once-in-a-lifetime limit previously imposed on PET scans. However, the decision on how many scans Medicare will cover will be left to its regional contractors.

PET scans are non-invasive and can detect the presence of brain plaque called amyloid. They are particularly helpful in determining whether a patient is a good candidate for new treatments like Leqembi, a drug recently approved by the Food and Drug Administration. Medicare will cover the cost of Leqembi, but patients must have a diagnosis of mild cognitive impairment or mild Alzheimer’s disease with documented evidence of amyloid on the brain.

Leqembi belongs to a new class of anti-amyloid drugs that specifically target amyloid brain plaque, a known cause of Alzheimer’s. According to the Centers for Medicare and Medicaid Services, PET scans can not only assist in patient selection for treatment but also demonstrate treatment response.

This decision eliminates a major barrier to accessing anti-amyloid therapies. Healthcare providers can now screen patients for eligibility and monitor for potential side effects such as brain swelling.

PET scans are preferred by patients as they are less invasive compared to alternative diagnostic tools like spinal taps. After meeting their deductible, Medicare patients generally pay 20 percent of the cost of a PET scan.

This move aligns with the agency’s proposal to expand access to Alzheimer’s treatments, and it has received support from advocacy groups advocating for broader coverage. The decision brings hope to patients and their families affected by Alzheimer’s disease.

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