Improved Alzheimer's Diagnosis Access: CMS Expands Amyloid PET Scan Usage

The U.S. Centers for Medicare and Medicaid Services has revised its policy permitting multiple uses of amyloid positron emission tomography (PET) scans, a non-invasive brain scan crucial for identifying amyloid plaques, a telltale sign of Alzheimer's. 

"Amyloid PET scans are a proven tool and can be an important part of Alzheimer's diagnosis and treatment," Maria Carrillo, chief science officer of the Alzheimer's Association, said in a statement.

Related: Is There A Blood Test for Alzheimer's? Progress Underway, But Not Quite Ready

This shift is essential as it aligns with the eligibility criteria for newly developed Alzheimer's drugs.

Amyloid PET scans were previously limited to a one-time use and primarily available for clinical trial purposes. However, this change opens the door for a more extensive and accessible diagnosis of Alzheimer's, paving the way for earlier, more accurate detection and determining treatment eligibility.

This move benefits patients seeking access to Alzheimer's drugs, including Eisai Co Ltd ESALY/Biogen Inc's BIIB Leqembi, along with Eli Lilly And Co's LLY experimental drug, donanemab. 

These drugs focus on removing beta-amyloid, a protein associated with the progression of Alzheimer's, from the brain.

Furthermore, this policy change ensures that individuals can be eligible for government reimbursement for drugs like Leqembi and others by confirming the presence of amyloid in the brain. This confirmation is critical and is now more accessible without invasive cerebrospinal fluid tests, such as lumbar punctures.

Citing RBC Capital Markets, an analyst Reuters reported that the change clarifies reimbursement for PET scans.

"While it will likely take some months for the MACs to establish their own reimbursement terms, PET scans have been one of the key initial bottlenecks for Leqembi uptake," the analyst said.

Disclaimer: This content was partially produced with the help of AI tools and was reviewed and published by Benzinga editors.