Imaging industry urges change in reimbursement for Alzheimer’s PET scans

Imaging industry urges change in reimbursement for Alzheimer’s PET scans

par Lisa Chamoff, Contributing Reporter | January 29, 2020
Alzheimers/Neurology Molecular Imaging
Congresssman Bobby Rush (IL) addresses the room
Alzheimer's researchers and patient advocates gathered on Capitol Hill Wednesday to support passage of a law that they say would increase access to molecular imaging used to diagnose and gauge progression of the disease.

The Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019, also known as H.R. 3772, would address the way the scans are packaged for Medicare reimbursement in outpatient facilities, which currently limits patient access to the scans.

Currently, the Centers for Medicare and Medicaid Services reimburses outpatient facilities for radiopharmaceuticals as part of the packaged cost of the procedure, which researchers say disincentivizes the utilization of many radiopharmaceuticals.

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The briefing, hosted by the Medical Imaging & Technology Alliance (MITA), along with the Council on Radionuclides and Radiopharmaceuticals Inc. (CORAR), and the Society of Nuclear Medicine & Molecular Imaging (SNMMI), gathered together a variety of speakers to discuss the importance of access to amyloid PET imaging for diagnosing, researching and treating Alzheimer's.

Geri Taylor, a healthcare executive with Alzheimer's who, along with her husband Jim, advocates for increased participation in Alzheimer's clinical trials, spoke about participating in a clinical trial for the drug Biogen after a confirmed diagnosis with an amyloid PET scan.

"When the PET results were positive, I knew definitively I had Alzheimer's," Taylor said. "The daily uncertainty of my life was resolved. Only individuals with positive PET scans were admitted to clinical trials. Before, they were admitted only based on symptoms. We now know the results of older trials were corrupted by participants who didn't actually have the disease."

Gersham Dent, senior director of development imaging at Biogen, said scans are used to enroll patients in the correct clinical trials, and administer the correct dosages. Correct reimbursement would help more patients benefit from new therapies.

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